FS24 Self-Directed Support Direct Payments and Personal Budgets August 2010 Fcs

8/3/2019 FS24 Self-Directed Support Direct Payments and Personal Budgets August 2010 Fcs

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Factsheet 24 August 2010 – AM066 1 of 43

Factsheet 24 August 2010

Self-directed support: Direct Payments andPersonal Budgets

About this factsheet

This factsheet outlines the development of self-directed support within the

Government‟s personalisation agenda. Direct Payments presently sit within

personalisation as a funding option and also exists independently as the

means by which cash payments can be made to eligible individuals to meet

their needs. Section 2 of the factsheet consists of an in-depth summary of

Direct Payments. The following sections focus on aspects of personalisation,

including information on the intended increase of service user choice and

control over the funding and provision of services, funding choices within

Personal Budgets, risk management and safeguarding, the preventative

agenda, carers rights to services, support brokerage and the central role of

advice and information for all those with needs in the community.

The information in this factsheet is correct for the period August 2010 – July

2011. However, legislation and guidance may change throughout the year.

The information given in this factsheet is applicable in England and Wales.

Different rules may apply in Northern Ireland and Scotland. Readers in thesenations should contact their respective national offices for information specific

to where they live – see section 10 for details.

For details of how to order other factsheets and information materials

mentioned inside go to section 10.

Note: Many local Age Concerns are changing their name to Age UK.




Inside this factsheet

1 Recent developments 3 2 Direct Payments 3

2.1 What are Direct Payments? 3 2.2 Who can have a Direct Payment? 6 2.3 The extension of Direct Payments 6 2.4 How to get a Direct Payment 8 2.5 The level of your Direct Payment 10 2.6 Direct Payments for carers 11 2.7 Using your Direct Payments 12 2.8 Arranging your own services 13 2.9 Support services for people receiving Direct Payments 17 2.10 Monitoring and reviewing your Direct Payment 17

3 The development of personalised services 19 3.1 Self-directed support 21 3.2 Personal Budgets 22 3.3 The Personal Budget process 24 3.4 The Resource Allocation System (RAS) 29 3.5 Support planning, brokerage and information 31 3.6 Ongoing support services 33 3.7 Personalisation and carers 33 3.8 New approaches to service provision 34

4 Early intervention and prevention 35 5 Risk management and safeguarding 36 6 Complaining about a decision 37 7 Useful organisations 37 8

Appendix 39

9 Further reading 40 10 Further information from Age UK 41




1 Recent developments

From October 2010, adults who fund their own residential or non-residential

social care will have access to an independent complaints review service

provided by the Local Government Ombudsman. This right is included in

the Health Act 2009 .

The re-registration of all regulated adult health and social care service

providers with the Care Quality Commission commenced in April 2010. In a

staged process adult social care services will be required to register on 1

October 2010. This means that the present registration under the Care

Standards Act 2000 continues until 30 September 2010.

Following the publication of the White Paper entitled Equity and excellence:

Liberating the NHS , the new Coalition Government set up a Commission on

the Funding of Care and Support in July 2010. This is looking into fundingsocial care services and it will report in the summer of 2011.

2 Direct Payments

2.1 What are Direct Payments?

Direct Payments are cash payments to an individual from a local authoritythat are an alternative to directly arranged community care services. Rather

than the local authority social services department providing or arranging the

community care services it has assessed you as needing, you receive money

to enable you to arrange your own services, allowing you more choice and

control over the way your care and support needs are met. They are also

available to carers, see section 2.6.

Direct Payments are also now one option that can be chosen by you to fundpart, or all, of your Personal Budget. These are a new way of arranging and

funding social care services and are discussed in detail in section 3.

Direct Payments presently stand alone in areas where the new

personalisation system has not yet been fully integrated. It is important to

understand the requirements and responsibilities that come with using a

Direct Payment and its eligibility criteria. This will be discussed in depth in this

section.




Direct Payments were first introduced under the Community Care (Direct

Payments) Act 1996. The Department of Health (DoH) set out how local

authorities should develop and administer their Direct Payment schemes in

Community Care, Services for Carers and Children‟s Services ( Direct

Payments Guidance) 2003 . Since April 2003, local authorities have had alegal duty to offer Direct Payments if the person is willing and able to

manage them, with or without assistance, and if they are eligible given all of

their circumstances. See section 2.3 about the new eligibility extension to

those who lack capacity to make this decision.

If you are eligible you must be offered the choice of having your

assessed needs met through Direct Payments rather than through

services provided or arranged by your local authority, as part of your

support planning process.

This process may also overlap with Personal Budget service options, which

should also be clearly explained to you. If individuals wish, they can arrange

mixed packages with some directly provided services and Direct Payments

for other needs. This can, for example, give somebody the opportunity to

familiarise themselves with having Direct Payments before taking on

responsibility for arranging support to meet all their needs.

Direct Payments can be used to arrange a wide range of services based onthe eligible needs identified in your needs assessment. However, it cannot be

used to arrange long-term residential care. You can choose to have some of

your services provided or arranged by social services, and use Direct

Payments to arrange the rest for yourself. Services can also include

equipment such as aids and equipment to help you get around or to assist

you with daily activities in the home. Within certain constraints laid down by

law, you can use the Direct Payment in the way you want to meet your needs.

Direct Payments can only be paid towards the cost of services that the social

services have assessed you as needing. These are called „eligible‟ needs

because they are based on the local authority eligibility criteria. They cannot

be offered for needs that do not meet the eligibility criteria. See Appendix 6.




Each local authority decides who can get services based on its interpretation

of its eligibility criteria, which they must publish. If you are refused a Direct

Payment on the grounds that you would not be offered services, you can use

the complaints procedure in the same way as anyone else refused services.

For further information about your rights to community care services see Age

UK‟s Factsheet 41, Local authority assessment for community care services .You may be asked to contribute towards the cost of your care services. Your

contribution is calculated using the same means-test rules as if the local

authority were directly providing or arranging services.

Case study

When Helen’s arthritis and angina got worse, her daughter requested

a social care needs assessment. She was found to need regular care

at home to help with housework and personal care.

„I‟ve always prided myself on being independent and managing on my

own, but when my health problems got worse I realised I needed help to

stay living at home. After my assessment, the council arranged for a care

worker to come round every morning to help me get up, washed, and

dressed, and do a bit of cleaning.

This helped me a great deal, but I wished my care worker didn‟t come so

early every day – I could never have a lie-in. And having a different carer every day wasn‟t ideal either.

I talked to my social worker and she explained about Personal Budgets.

My daughter and I read up on it and I decided to go for a Personal Budget

in the form of Direct Payments . I use them to employ a personal

assistant, who really understands my needs and fits in well with me. I

interviewed a few people before I chose her. She comes a bit later on

Fridays so I can sleep in, and takes me to my local café for breakfast once

a week.

The paperwork for Direct Payments sounded daunting, especially as my

rheumatoid arthritis makes it difficult to write, but my daughter helps me fill

in forms and I can file them myself. It isn‟t hard to manage, and I know that

my council has a Direct Payment support service to help me should I need

it.




2.2 Who can have a Direct Payment?

To be eligible for a Direct Payment you must be:

aged 16 or over

a disabled person as defined by section 29 of the National Assistance Act

1948

assessed as needing services, within the meaning of section 46 of the

National Health Service and Community Care Act 1990

The definition in the 1948 Act may now seem outdated but should be taken to

include people who have any kind of impairment caused by physical

disabilities, sensory impairments, learning disability, or are affected by an

illness or condition (such as mental illness, arthritis, multiple sclerosis,

HIV/AIDS, a heart condition, etc).

Local authorities have a legal duty to offer Direct Payments to all service

users who meet the eligibility rules.

Note: some other groups, such as those with parental responsibilities for a

disabled child, may be eligible for Direct Payments but they are not the focus

of this Factsheet.

2.3 The extension of Direct Payments

The Health and Social Care Act 2008 amended existing legislation to extend

the scope of Direct Payments. In November 2009, under the new Community

Care, Services for Carers and Children‟s Services (Direct Payments)

(England) Regulations 2009, Direct Payments became available to people

who lack the capacity to consent, and to people with mental health problems

who are subject to mental health and certain criminal justice legislation.




Direct Payments for adults lacking capacity to consent

All local authorities must now offer Direct Payments to certain eligible adults

who lack the mental capacity to consent to receive them. They can now be

made to a willing and appropriate ‘suitable person’, who receives and

manages the payments on behalf of the person who lacks capacity.

Guidance1 to local authorities outlines the process to be followed forappointing a suitable person, the conditions to be met by them, how to

resolve disputes, when advocacy may be appropriate and approaches to risk

and safeguarding.

The suitable person will often, but not always, have been given a Lasting

Power of Attorney or have been appointed by the Court of Protection as a

Deputy under the Mental Capacity Act 2005 . Usually the suitable person will

be a family member or friend who may previously have been involved in the

care of the person eligible for services.

The new Regulations reflect the standards and protections set down in the

Mental Capacity Act 2005 .

The Mental Capacity Act 2005 states that:

A person lacks capacity if he is unable to make a decision for himself in

relation to a particular matter [at the time] because of an impairment of, or

a disturbance in the functioning of, the mind or brain.This must be judged on an individual basis relating to a specific decision and

may need to be reviewed in future. All practical steps should be made to

support or facilitate the decision making process and no assumptions should

be made. Anyone who is working with or caring for an individual who lacks

mental capacity must adhere to the „best interest‟ standards described within

the 2005 Act and should familiarise themselves with its requirements. For

further information about this see Age UK‟s Factsheet 22, Arranging for

others to make decisions about your finances and welfare. See also Age UK‟sFactsheet 78, Safeguarding older people from abuse .

1 Guidance on Direct Payments – For co mmunity care, services for carers and children‟s

services: September 2009, Department of Health.




Direct Payments for people subject to mental health legislation

Local authorities now have the same duty to offer Direct Payments to eligible

people who are subject to mental health legislation as they do to anyone else

in all but the following cases:

People who are on conditional discharge from hospital under the Mental Health Act 1983 , where councils will now have a power (but not a duty) to

offer Direct Payments.

In respect of a service which a person is obliged to accept as a condition

of relevant legislation, local authorities are not required to offer Direct

Payments for that particular service – but have a power to do so. This

includes conditions attached to guardianship, leave of absence from

hospital or a community treatment order under the Mental Health Act 1983

and certain provisions in criminal justice legislation. This means thatcouncils now have a duty to offer Direct Payments to such a person in

respect of a service which is not the subject of a condition if the person is

eligible. All the relevant legislation is listed in Annex B of the Guidance2.

Note: a „power‟ means the local authority can use their discretion but must

give reasons if challenged on the resulting decision.

People who are still excluded

People who are subject to drugs and alcohol-related provisions of somecriminal justice legislation remain excluded from receiving Direct Payments.

The legislation in question is listed in Schedule 1 of the new Regulations and

in Annex C of the Guidance3.

2.4 How to get a Direct Payment

If you do not currently receive a Direct Payment or have services arranged or

provided for you, you can ask the local authority to carry out an assessmentof your needs.

2 Guidance on Direct Payments – For community care, services for carers and children‟s

services, Annex B: 2009, Department of Health.

3 Guidance on Direct Payments – For community care, services for carers and children‟s

services, Annex C: 2009, Department of Health.




Direct Payments are now one funding arrangement choice within the new

personalised system of social care and should be offered alongside other

options (see section 2.3).

If you meet the eligibility criteria Direct Payments must be discussed and

offered by the local authority following an assessment of your care needs and

as part of your support plan. You can also request to switch to DirectPayments rather than continue to have services arranged or provided by the

local authority. This can be done at any time, for example at a review of your

care and support package.

Action: Contact your social services department for more details of Direct

Payments. The local authority‟s local long-term care charter, called Better

Care, Higher Standards , should explain the possibilities of benefiting from

Direct Payments, as well as their information on personalisation.

If you are considering whether to have a Direct Payment, or have decided

that you want to use Direct Payments but have not yet had time to arrange

your own services, you should not be left without the services you need in the

mean time. You may need to have services arranged by the social services

department until you are able to put your own services into place. The local

authority is only relieved of duty to provide services if it is satisfied that your

needs are being met. If they are not, the local authority has a duty to providethe services directly.

Obtain as much information as possible so that you can make an informed

choice about whether Direct Payments are the best option for you. Your local

authority may have its own guide, or be able to put you in touch with a

support group or with other people who already have Direct Payments.

Deciding if you can have a Direct Payment

The judgement about your eligibility should be made on an individual basis,

taking into account your views. This also applies to the decision as to whether

there is a „suitable person‟ available to manage the Direct Payments on

behalf of someone who lacks capacity to choose to have them. You can

receive assistance in managing a Direct Payment, but you should have as

much control as possible over how your support services are delivered to

meet your needs.




You should not be refused a Direct Payment just because you will need help

with managing it, initially or in the long term. Social services should consider

what assistance might enable you to manage, rather than assuming that you

will be unable to. If you are refused a Direct Payment on the grounds that it is

considered that you could not manage, the reasons should be explained to

you. You could use the local authority complaints procedure to challenge thedecision.

If you meet the eligibility criteria and start to receive Direct Payments but later

lose mental capacity, someone who holds Lasting Power of Attorney over

your care needs and financial affairs can continue to receive payments on

your behalf. They can also request Direct Payments on your behalf once you

have lost capacity if this is in your „best interests‟ as defined by the Mental

Capacity Act 2005 . If you need further information on this issue you can call

the Office of the Public Guardian. Their helpline phone number is 0300 4560300.

2.5 The level of your Direct Payment

Your Direct Payment must be enough to enable you to meet all the related

legal obligations and to secure a service of a standard that meets your

assessed needs.

The authority will not usually make a Direct Payment for more than it

calculates that it would cost to provide (or arrange) the service. The estimated

cost should include any associated costs (such as employer‟s National

Insurance contributions, sick pay, holiday pay, employer‟s liability insurance,

VAT, etc).

The authority can pay more than its estimated cost of providing the service if

it is satisfied that the increased cost is justified because it is more effective inenabling the person to manage his or her own services and live

independently.

If your preferred method of securing services will be more expensive than the

council‟s estimate of the reasonable cost of doing so, you may have to meet

any shortfall yourself. However, you can complain if you think that the local

authority has been unduly restrictive about the amount it will pay.




Your contribution towards the cost of your care

You may be asked to contribute towards the cost of care arranged using

Direct Payments, in the same way as if the local authority has arranged or

provided services. Local authorities have a discretionary power to charge for

non-residential services and most do so. See Age UK‟s Factsheet 46, Paying

for care and support at home , for more details of charging for domiciliaryservices.

Your Direct Payment can either be made net of your assessed contribution

(i.e. the estimated cost less your contribution) or including your contribution

and you repay your contribution to the authority. In practice it is likely that the

Direct Payment will be made net, but if you are in dispute with the local

authority about the amount you are expected to pay, you should ask to be

paid the full amount until the dispute is settled. In this way you are in the

same position as someone who receives services while the level of their

charge is being resolved.

Local authorities should give you as much notice as possible before the

Direct Payment starts or the level is changed in order to resolve any disputes.

If you disagree with the amount you are being charged you can complain.

2.6 Direct Payments for carers

The Carers and Disabled Children Act 2000 gives local authorities powers to

offer assistance to anyone who provides regular and substantial care to

someone who might need community care services. Carers also have rights

to an assessment of needs in their own right as well as being included in the

service user‟s local authority needs assessment.

A local authority may decide that a person requires services because they

provide, or intend to provide, a substantial amount of care on a regular basis

for someone aged 18 or over. Carers (but not employees, persons workingunder contract or volunteers for a voluntary organisation) may obtain Direct

Payments in respect of their own assessed needs for services as carers.

The types of help that can be given are wide-ranging and not limited to

community care services. For example, if the person cared for refuses to

accept help from anyone but a relative, the local authority might provide the

relative with help with housework so that they had free time to assist the

person who needed help.




The carer does not need to live in the same household as the person cared

for, and they do not need to be actually receiving, or to have been assessed

as needing a community care service.

See the Information Guide entitled Advice for carers for further information on

carers‟ rights. Carers UK provide information on all aspects of carers‟ rights.

See section 7, Useful organisations, for their contact details.

2.7 Using your Direct Payments

You can use your Direct Payments however you wish as long as it is to meet

your assessed eligible needs. Although social services departments need to

set conditions to ensure this, the aim of Direct Payments is to give people

more choice and control over the care and support services they are

assessed as needing. Social services departments should not be constrainedby existing patterns of service provision. You might want to use your Direct

Payment to help you go shopping instead of having it done for you or to get to

a computer course to learn computer skills to enable you to keep in touch

with family.

Examples of Direct Payments

The National Centre for Independent Living (see section 7) gives an example

of someone who lived near the sea using his Direct Payment to be takenregularly to the seafront as this was very important to him. Someone else was

taken to a café where she could meet her friends. Another person used the

payment to get to her place of worship.

However, you cannot use Direct Payments to pay:

your spouse, partner or a „close relative‟ living in the same household (in

exceptional circumstance the local authority has discretion to allow this)

anyone who provides you with care – including someone who lives with you – if they are assessed as needing help (in exceptional circumstance the

local authority has discretion to allow this)

for social services‟ own provision. In this case you can either receive

services from the social services department in the normal way, or have

some social services provision and arrange some of your care yourself with

a Direct Payment




for services that the NHS has a duty to provide or for services provided by

housing authorities

for permanent residential care.

Note: Direct Payments cannot be used to pay for a period of residential care

lasting more than four weeks. If you have a number of short periods ofresidential care these will be added together unless each period of care is

separated by at least four weeks. You can only receive Direct Payments for a

total of four weeks of residential care added together in this way in any 12-

month period. If each period of residential care is less than four weeks long,

and there is at least four weeks between each stay, then you should be able

to claim a Direct Payment to pay for each period of care. All decisions about

this type of care and support should be agreed with you and be a part of your

needs assessment.

Close relatives definition

A close relative is a parent, parent-in-law, aunt, uncle, grandparent, son,

daughter, son-in-law, daughter-in-law, step-son or daughter, brother, sister or

the spouse of any of these. This restriction is intended to prevent Direct

Payments being used where the relationship is primarily personal.

Social services departments can make exceptions to this general rule if

securing the service from such a person is necessary to satisfactorily meet

the service user‟s assessed needs.

2.8 Arranging your own services

This section covers the issues around arranging your own services:

employing your own care workers or personal assistants

contracting with an agency or someone who is self-employed

buying your own equipment

dealing with emergencies.




A factsheet such as this can only give pointers you may want to consider.

Section 2.9 describes the support services that may be available and section

7 gives details of where you can get further information that covers these

issues in more depth.

2.8.1 Employing your own care workers or personal assistantsThis option gives you the greatest choice and control over your care services.

Some people worry about the responsibilities of being an employer but many

others have found it to be a successful way of arranging their services, and

that once systems have been set up, they run smoothly.

You may find that a local support scheme offers training and/or a payroll

service that helps with the tax and National Insurance aspects of being an

employer. There is also a national employer‟s helpline (see section 7).

Contact the National Centre for Independent Living for information about

employing a personal care worker, see section 7 for contact details. Issues

you will need to consider before recruiting a care worker include drawing up

job adverts and job descriptions, making sure you have covered all the tasks

you will want done, where to advertise, what to ask at interviews, how much

to pay, drawing up a contract so that both you and the person you are

employing are clear about the terms and conditions of the employment, what

insurance you will need and your legal responsibilities as an employer.The employment contract should also include: start date, hours of work,

remuneration (must meet national minimum wage), place of work, job title,

whether fixed-term or permanent, statutory entitlement to sick pay and annual

leave, pension scheme provision (where appropriate), and notice

requirements. 4 This ensures understanding of the employment terms at the

outset.

2.8.2 Contracting with an agency or someone who is self-employed

If you would prefer not to have the responsibility of being an employer you

can use your Direct Payment to contract with an independent agency or a

person who is self-employed.

4 Guidance on Direct Payment s, For community care, services for carers and children‟s

services, England 2009, Department for Children, Schools and Families, page 51.




It is important to check very carefully that the contract you make with

someone who is self-employed means that they are genuinely self-employed.

There can be financial consequences for you if you incorrectly engage

someone under self-employment, where the reality of the terms of the

engagement between you and the person reflects employment. You should

obtain appropriate advice about what is required from you and those youemploy if you are unclear about this. This should be available from the local

authority or a local voluntary or user-led organisation. The HMRC website has

an online tool to determine a worker‟s employment status called the

„Employment Status Indicator‟, which can be accessed at

www.hmrc.gov.uk/calcs/esi.htm.

Several different factors affect whether a person is considered to be self-

employed for the purposes of tax, National Insurance and employmentlegislation, including the terms on which they have been engaged and the

amount of control you have over the work done. The Inland Revenue

produces a leaflet which explains the difference between being employed or

self-employed (see section 9 „Further reading‟).

If you decide to use an independent care agency you should be able to find

local agencies in the telephone directory, through your local authority or by

personal recommendation. They must be registered with the Care Quality

Commission, the national agency responsible for regulating care services, toenable them to trade legally.

You may want to approach several agencies or self-employed people before

making a decision.

Before entering into an agreement, confirm the following with the agency or

individual involved: the tasks you expect the staff to do and the way in which

you would like them done; what the quoted price covers (some agencies add

VAT or charge extra for travelling); what insurance cover they have; whattraining the staff have had; cover arrangements for example for sickness; and

what happens if you have to cancel the service suddenly.

To avoid any future misunderstandings, your contract should be as clear as

possible. Agencies often use standard contracts that can be individualised. If

you are making your own contract with someone who is self employed,

examples of contracts may be useful (see section 9 „Further reading).




2.8.3 Buying equipment

If you are given a Direct Payment to buy equipment, take advice to ensure

that the equipment you are buying is safe, appropriate and cost effective. You

can liaise with the occupational therapy department at the social services who

may have been involved with initially assessing your needs. This applies to

smaller items that social services pay for rather than larger items andadaptations, which are funded by Disabled Facilities Grants from the housing

department. There are about 40 Disability Living Centres across the UK,

which display a wide range of equipment and have staff to give advice. If you

plan to use your Direct Payment for equipment, establish whether you or the

social services department will own the equipment and who will be

responsible for ongoing care and maintenance.

If your local authority is using elements of the individual budget system,

disability equipment funding may be included within a single budget with

other funding, allowing you more choice and control over how your assessed

needs are met.

See Age UK‟s Factsheet 32, Disability equipment and how to get it , for

information about community equipment.

Dealing with emergencies

The social services department‟s responsibility for agreeing and arrangingservices is the same as for any other service user. If the local authority

becomes aware that your assessed needs are not being met or you are at

excessive risk, it has a duty to act to resolve the issue. You should therefore

not be left without the support that you need, and should have a named

person to contact in an emergency to ask for help as part of your care plan.

Whatever arrangements you make, there may be times when equipment

breaks down. Discuss your contingency plans with social services so that

they are included as part of the care plan, and so that your Direct Paymentscan be adjusted accordingly to meet any related costs.

If you employ your own care worker, your contingency plans might include

making arrangements with an independent agency for emergency cover if

your care worker is sick or planned cover when your care worker goes on

holiday. Some support schemes offer back-up in the form of emergency staff.




2.9 Support services for people receiving Direct Payments

Support services for recipients of Direct Payments have been identified as a

key element in the successful implementation and operation of Direct

Payment schemes. The services may be run directly by the local authority or

in partnership with a local voluntary agency. In some areas there may be

separate support schemes for older people receiving Direct Paymentsreflecting the fact that this currently affects more older people than younger.

The type of support services offered should reflect the needs of local people

requiring services and their carers.

Services may include support, information and advice from those who

currently receive Direct Payments who can pass on what they have learnt;

training and practical assistance, particularly help with employing care

workers; lists of agencies, help with drafting adverts and contracts, providing

rooms for interviewing, or acting as an addressee for responses to adverts.

Some support groups may produce newsletters or hold regular meetings for

people to share their experiences.

The National Centre for Independent Living provides a national focus for

advice and information and useful reading materials (see section 7). Your

local social services departments should be able to tell you what local support

schemes there are and have materials with local information.

2.10 Monitoring and reviewing your Direct Payment

Although the social services department is not providing or arranging your

services, it is still responsible for making sure your needs are met and it also

has a safeguarding duty.

Monitoring arrangements to check that your needs have not changed and to

discuss any concerns you have should be agreed before you start to receive

your Direct Payment. Do not feel inhibited about expressing reservationsabout the services you are purchasing or any other problems. Your payments

should not be stopped automatically or arbitrarily as a result of your concerns.




There will also be financial monitoring to ensure that public funds are being

properly spent. Before your Direct Payments begin, discuss the information

you will be expected to provide and the way monitoring will be carried out.

You will normally be expected to keep separate accounts, including operating

a separate bank account for your Direct Payments. Audit arrangements

should be as simple and easy to understand as possible.The “Kent Card”

Kent County Council has introduced a scheme called the Pre-loaded

Card programme for Direct Payments recipients or the “Kent Card”, with

a major banking organisation. This is an automated system for handling

regular payments allowing service user choice and control, and

reducing administrative costs. The card is pre-loaded with an agreed

amount of money. This means that an individual does not have to

manage a bank account, a cheque book and debit card, or carry cash.It removes the need for the recipient to keep a separate bank account

or keep complex records of their care payments. A monthly statement,

in various formats, is sent to card holders. It can also be viewed on a

website, which acts as an audit tool. Another person can be nominated

to use the card on the service user ‟ s behalf. The recipient can also top-

up the card to purchase services costing more than the Council would

allow. Other local authorities such as Coventry are presently piloting

this approach. The Community Care (Direct Payments) Act 1996 enables local authorities to

require some or all of the money to be paid back if it has not been used for its

intended purpose. Before you receive Direct Payments the circumstances

when recovery may be considered should be explained to you. You should

not be penalised if you have made an honest mistake.

Monitoring of both services and financial arrangements is likely to be more

frequent in the early stages of your Direct Payment. Once the local authority

is satisfied that your arrangements are working and your financial accounting

is satisfactory, the monitoring is likely to be less frequent. You can ask for a

review at any time if you think there is a need.

You will need to sign a contract with the local authority that clearly states what

is expected of both you and the local authority.




2.10.1 Discontinuing Direct Payments

You can decide at any time to stop having Direct Payments. The local

authority should then arrange services for you instead so that your needs

continue to be met.

The local authority can decide to discontinue Direct Payments if it believesthat your needs are no longer being met, or you, or the person/people

supporting you, are unable to manage your payment, or there has been

misspending of the payments. You should be given the opportunity to

demonstrate that you can still manage your payment.

Any decision to discontinue your payment should only follow full discussion

with you and, if appropriate, your carer. You should be told the minimum

period of notice you will be given in these circumstances at the time you start

receiving Direct Payments.

3 The development of personalised services

In December 2007 a Government policy document entitled Putting People

First – a shared vision and commitment to the transformation of adult social

care declared that public service provision was to be personalised. This

included a „concordat‟ (agreement) between a number of Government

departments and other bodies intended to demonstrate the broad scope ofthe new policy development. In January 2008, the Department of Health

(DoH) published a Local Authority Circular entitled Transforming Social Care .

This was followed by a further Local Authority Circular in March 2009 (see

Appendix: 1 and 2).

These documents set out a shared ambition for a radical transformation of

services, promoting personalised support characterised by service users‟

ability to exercise choice and control over service provision. They also

emphasise the aim of working with all sectors and communities to deliver

whole system change to service provision. The Social Care Institute for Excellence (SCIE) described personalisation in

their 2008 publication Personalisation: a rough guide :




Personalisation reinforces the idea the individual is best placed to know

what they need and how those needs can be best met. It means that

people can be responsible for themselves and can make their own

decisions about what they require, but that they should also have

information and support to enable them to do so. In this way services

should respond to the individual instead of the person having to fit with the service.

Personalisation is an attempt to provide services in a more person-centred

way, to more closely reflect individual needs. In this way it is hoped to achieve

better outcomes for the individual and to reduce to the feeling that they are

being fitted into pre-defined services. Policy documents have used the term

‘co-production’ to describe this more collaborative approach that

encourages people to actively engage in the design and delivery of services -

the opposite of being a passive recipient of services.

Central to providing more choice and control is ensuring that everyone with

needs has appropriate access to information, advocacy and advice to

make informed decisions about their care and support regardless of their

financial situation. This is discussed further in section 2.7.

Recognising and supporting carers in their role, while enabling them to

maintain a life beyond their caring responsibilities is also a major aspect of

the policy.This approach links to broader policy aims intended to improve social

inclusion and the use of existing social capital and resources within the

community. It also includes commissioning for early intervention and

prevention (discussed in section 3) and more effective joined-up service

provision.

The personalisation policy agenda aims to ensure that information and

advice, improved access to universal services, community engagement

and social capital, as well as prevention and early intervention, are for

all people with care and support needs, not just those who are eligible

for Personal Budgets and Direct Payments.




The new Coalition Government appears to be supportive of the

personalisation agenda. Good progress has been made towards

implementation in many areas; this is required because Government targets

of 30% take up by March 2011 have been set for local authorities, which may

be challenging particularly in the context of the Government‟s planned budge

cuts. Personal Budgets and self-directed support are intended to become themain mechanism for delivering social care support in the future.

Action: If you would like to explore the option of a Personal Budget you

should contact your local authority to discuss what is available. You may not

presently be receiving a service or could be receiving a service that is directly

controlled by the local authority; you may also already have a Direct

Payments arrangement.

It could be useful for you to discuss this option with support agencies such as

Age UK, who have local knowledge of services and who may also provide a

support brokerage service.

3.1 Self-directed support

It is helpful to think of ‘self -directed support’ as an overarching term

describing a variety of tools and ways of working to give people greaterlevels of control over how their support needs are met – the mechanism

by which Personal Budgets are delivered.

It is about you having as much control as possible over how the money

available for your care and support is spent. The idea is that you can tailor

support to your requirements, preferences and required outcomes with

appropriate support within a framework agreed with the local authority.

Funding for support should be agreed in a fair, transparent and flexible way,

controlled by you in away that you choose.

Over the past few years many people have found that Direct Payments have

allowed them to gain greater control over the services provided to meet their

needs. The new drive towards personalisation and self-directed support is

intended as a more systemic approach, to give similar opportunities to as

many people as possible. Direct payments, now one funding arrangement

option for a Personal Budget, is discussed in detail in section 2.




Take-up issues

There are outstanding issues about the level of take-up among certain

groups. Older people, for example, appear less inclined to take on the

responsibility of directly managing their own funding through Direct

Payments. However, the Government is taking steps to resolve this issue5.

3.2 Personal Budgets

Personal Budgets, which include using Direct Payments, are within the

existing social care legal framework and do not change your existing rights to

have your eligible needs met by the local authority following an assessment

of your needs.

A Personal Budget is a sum of money allocated to an individual who is

assessed as needing personal assistance and support services in a non-

urgent situation; it is generally restricted to social care funding. Personal

Budgets were introduced in local authorities from April 2008 (see Appendix:

4). Policy guidance states that they should be an up-front allocation of

resources allowing you to plan how to meet your needs and required

outcomes with appropriate support.

Terminology

Outcomes are what you see yourself as being able to manage to do

regarding your daily tasks and needs, and also what you wish to do or

achieve in a broader sense. These aims and wishes may be achievable with

appropriate advice and support, or by other means such as adapting your

living environment.

Personal Budgets are part of a local authority‟s system of means-tested, non-

residential social services provision, which means that you may be asked tocontribute to the cost of services. For more information on the means test

process see Age UK‟s Factsheet 46, Paying for care and support at home.

Trials are also taking place for the introduction of personal health budgets in

the NHS. This should allow more joined-up service provision between health

and social care, for example with regard to NHS Continuing Care.

5 Personal Budgets for older people: making it happen, January 2010 .

http://www.puttingpeoplefirst.org.uk/Topics/Browse/Olderpeople/?parent=2736&child=7085




Individual budgets are no longer being promoted

Originally Personal Budgets were planned to be introduced alongside

individual budgets. These were similar to Personal Budgets in their aim of

increasing service user choice and control over service provision and funding

but they were intended to allow access to a wide range of local authority and

other benefit funding streams to create a single individual budget.

However, in a Pilot Programme run in England over two years and ending in

2007, major difficulties were found regarding the integration of the various

funding streams. These difficulties could not be surmounted without changes

to legislation and administration rules. As a result individual budget are not

currently being promoted by the Government. However, some local

authorities may be using elements of the individual budget approach

alongside the purely social care funds included in Personal Budgets.

The 2010 edition of Personalisation: a rough guide carries the following

guidance about terminology, at page 9:

The government is focusing on using only social care money in the

immediate future – this is known as a Personal Budget. The Department of

Health has said that the term individual budget is no longer in use and that

the correct term for the allocation of social care funding to an eligible adult

through self-directed support is a Personal Budget.

Note: As a result of this we are only using the term „Personal Budgets‟ in this

factsheet.

The ‘Right to Control’

The Office for Disability Issues is piloting the „Right to Control‟, based on

requirements laid down in the Welfare Reform Act 2009 . The aim is to create

a streamlined approach to assessing and responding to the needs of a

disabled person so that they can have choice and control over a single

budget allocated to meet agreed outcomes. This reflects the developments of

personalisation in social care and has similarities to individual budgets, which

are not presently being promoted by the Government. The pilot sights

(„Trailblazers‟) will explore funding streams including:

Work Choice

Access to Work

Independent Living Fund




Disabled Facilities Grant

3.3 The Personal Budget process

At present Personal Budgets are not intended for long-term residential care

but this may be introduced in the future. However, the new personalisedapproach is already having an effect on the services provided in residential

care and more widely within services such as housing associations.

Choice and control over funding arrangements

If you choose to have your services provided via a Personal Budget, you can

have the local authority contribution paid in a number of ways:

direct (cash) payments, held directly by the person or, where they lack

capacity by a „suitable‟ person

an account managed by the local authority in line with your wishes - also

known as a „virtual budget‟

an account held with a third party and managed by you. This could be with

a service provider in the form of an Individual Service Fund (ISF), which

can be a way for you to manage your needs without being responsible for

a budget

It could also include an account managed by a carer, friend or relative inthe form of a User Controlled Trust. Trustees have certain legal

responsibilities and should be aware of these. These are based on the

trust deed and related trust law. Arrangements like this can allow you to

benefit from Direct Payments without the burden of managing the budget

yourself.

as a mixture of the above to best suit you needs and aims.




Innovative ideas

Some councils operate small payments schemes where Direct Payments

within a pre-agreed limit can be given direct to individuals for support

needs. A Direct Payment agreement is still required, but the person does

not need a separate bank account and monitoring is done principally

through the review process. This can provide a straightforward way for people to purchase equipment or one-off services. In other instances

councils use vouchers to make these payments, although these can be

more restrictive (e.g. are limited to specific purchases/brands/outlets).

Warwickshire County Council operates a scheme for small payments up to

£500 whereby one-off payments can be made to individuals without the

need for a separate bank account.6

Personal Budgets build on the approach of Direct Payments. The monetary

value of a Personal Budget is related directly to the eligible needs of a

person, with guidance stating it does not always have to be strictly based on

hours of service. Direct Payments are the method by which local authorities

are legally allowed to make cash payments to an individual (or another

„suitable person‟) so they can arrange services to meet their needs.

You have a right to have your Personal Budget managed in the way that

best suits you and should not be under any pressure to accept a direct

cash payment to arrange services yourself. You should always receive

the necessary advice and support (free of charge) to make an informed

decision about how your services are funded and arranged.

6 Personal Budgets for older people: making it happen, January 2010 .





Policy guidance on Personal Budgets requires that you should know upfront

how much money there is to spend over a year so that you can decide with a

support worker or Support Planner how to design your care package to meet

your identified needs. Whereas Direct Payments were often used to employ

personal assistants, Personal Budgets are being promoted as being more

flexible with regard to meeting individual needs and preferences, includingthe purchase of ordinary community or commercial services (for example,

gym membership rather than day-centre attendance) or to pay relatives and

friends for the help they provide. However, see the present restrictions on the

use of Direct Payments regarding close family members in section 2.7.

Case study

When Mary had a stroke that left her with reduced mobility, she

qualified for help from social services. She wanted more flexible care

to feel more independence and control.

„When I had a stroke two years ago, it left me with various problems. It

was hard for me to get out of bed on my own and I had some difficulties

with washing and dressing. I needed someone with me whenever I left the

house in case I fell, but my husband has his own health problems so he

couldn‟t help me. I used to do all the housework so seeing the house

getting increasingly messy and untidy made me feel very depressed.

I had a community care assessment from my local council, and they put together a care plan for me. Carers from a care agency came round each

day to help with my personal care, to do some cleaning, and get my

shopping for me. It helped a lot but I wanted something more flexible so I

could have more independence and control.

I explained this to my care manager and we talked to my husband and my

care agency about what would be best for me. As a result of these

discussions I agreed to have a Personal Budget in the form of an

Individual Service Fund . This means my care agency holds the money

I‟ve been allocated by the council, and I control how it‟s spent. I liked my

regular carers so I‟m really happy I‟ve been able to keep them.




3.3.1 A typical Personal Budget process

The process generally involves:

a range of possible needs assessment approaches, for example a self-

assessment questionnaire, with appropriate support and assistance; it

must include an assessment by the local authority - a legal duty a decision by the local authority as to whether the identified needs (in the

care assessment) meet their eligibility criteria for service provision

discussion with the service user about whether they would like to use the

option of a Personal Budget to meet their care and support needs and

which funding arrangement option may be suitable

the eligible needs identified in the assessments feed into the Resource

Allocation System (RAS) where an indicative (estimated) budget is agreedand communicated to the service user

a means test (financial assessment) is carried out to determine whether a

contribution to service provision is required from the service user. Other

necessary means tests and assessments may be included if elements of

the individual budget approach are being used

a „self -directed‟ support planning process commences to work out how to

meet the individual‟s priorities, goals and planned outcomes. Support,advice and information may come from a local authority care manager, an

in-house or external specialist Support Planner or Broker, the individual‟s

family and friends, a service provider or a local user-led or voluntary

organisation. This informs and supplements the statutory local authority

assessment

a senior person or possibly a panel at the local authority agrees („signs

off‟) the support plan taking into account the agreed eligible needs and

planned outcomes, including an assessment of risk and any safeguardingconcerns. Changes to the level of the Personal Budget may need to be

agreed at this time in order to meet assessed needs, bearing in mind that

the initial RAS is only an estimate for planning purposes

the service is provided based on the chosen funding arrangement

option/method, for example through a User Controlled Trust, with

appropriate support




soon after the service commences the case is reviewed to check that the

support plan is meeting all eligible needs, there are no safeguarding/risk

issues, and that the indicative amount (RAS) is adequate; any necessary

adjustments are made

regular reviews follow, taking into account changing needs and the

possible consequences for the RAS funding amount.

3.3.2 Self-directed assessment

As part of personalisation the use of self-assessment questionnaires has

become more commonplace as this is seen as central to the supported self-

directed assessment process. A wide range of tools have been introduced

to assess people‟s needs in a more person-centred way. This achieves the

aim of being led as far as possible by the service user, focusing more closely

on required outcomes and allowing more individualised and creative care and

support plans.

However, the shift towards self-assessment is one of balance rather than a

fundamental shift of responsibility from the state to the individual within the

assessment process. ADASS7 stated in a recent document that: „Contracting

out‟ of eligibility, resource allocation and support planning decisions is not

lawful, but the contracting in of help, in terms of fact-gathering and support for

clients, in relation to the decisions that the authority ultimately needs to make,is already legitimate.‟

The duty of the local authority to carry out an assessment of needs is a legal

requirement, which it cannot delegate to any other person or body. Needs

identified in the assessment that meet the local authority eligibility criteria

must be met.

In a recent charging case, R (B) v Cornwall County Council (2009) 12 CCLR 381, the judge ruled as unlawful the practice of self-assessment standing

alone as the only assessment. Here it was stated that:

7 Personalisation and the law: Implementing Putting People First in the current legal framework,

October 2009. ADASS is the Association of Directors of Adult Social Services.

http://www.dhcarenetworks.org.uk/_library/Resources/Personalisation/Personalisation_advice/A

DASS_Personalisation_and_the_law_12.10.09.pdf




The [local] authority cannot avoid its obligation to assess needs etc by

failing to make an appropriate assessment themselves, in favour of simply

requiring the service user himself to produce evidence of his needs.

In the new local authority eligibility guidance8 the local authority assessment

duty is confirmed and self-assessment is described as a „useful tool‟ to be

used proportionately. The new policy guidance incorporates many of theprinciples of personalisation but is similar to the previous Fair Access to Care

Services (FACS) guidance in its eligibility banding system: Low, Moderate,

Substantial and Critical risks related to „independence and wellbeing‟.

For more information about assessments see Age UK‟s Factsheet 41, Local

authority assessment for community care services.

3.4 The Resource Allocation System (RAS)At the heart of the Personal Budget process is the Resource Allocation

System (RAS), which gives you an indication of how much money you can

expect so that you can decide how best to meet your care and support needs

with appropriate support.

The RAS process usually takes the following form in local authorities. The

level and type of assistance you need across the areas (domains) within the

eligibility criteria are itemised to achieve particular outcomes, and each itemis scored to reflect the level of support and assistance required. Your total

score is then translated into a single sum of money - an up-front allocation

of funds to enable you to plan to achieve your required outcomes.

Concerns about the RAS

Age UK has concerns that „one size fits all‟ points allocation systems may not

adequately reflect the complexities of individual cases and could also have

inherent inequalities. This relates to the use of a range of supported

assessment questionnaires for different client groups and various levels of

points allocation and budgets being awarded to different client groups.

8 Prioritising need in the context of Putting People First: a whole system approach to eligibility for social care

- guidance on eligibility criteria for adult social care, February 2010, Department of Health.




There are also concerns about the flexibility of indicative (estimated) budgets

once they have been allocated. Recent research by Age UK found a variety

of views among local authorities about modifying the allocated amounts if

issues arise about their adequacy.

Case law on the RAS

Recent case law has shown the courts‟ continuing rejection of any blanket

approach to resource allocation. An example of this is the approach taken

in R (JL) v Islington (2009) 12 CCLR 322 . This case concerned the practice of

allocating points to identify a band (high, medium or low) for provision of a

Personal Budget, in this case to support a disabled child and her mother. The

judge, Black J, found it:

hard to see how a system such as this one, where points are attributed to

a standard list of factors, leading to banded relief with a fixed upper limit,can be sufficiently sophisticated to amount to a genuine assessment of

an individual child‟s needs. There will be times when, fortuitously, the

needs assessed by such a system will coincide with the real needs of the

family, but it is difficult to have any confidence in that occurring sufficiently

frequently to justify the use of eligibility criteria on their own.

This underlines the importance of the initial RAS calculation being treated as

an estimate, subject to revision in light of the individual‟s emerging or

changing needs. Many people come into contact with the social services in acomplex crisis situation. This requires staff involved to fully engage in the

assessment process to make sure the local authority fulfils its legal duty to

meet the eligible identified needs identified, including providing the necessary

funding.

The courts have also stated that local authorities must give reasons as to how

they reach a decision about the level of a personal budget allocation in

(R(Savva) v Royal Borough of Kensington and Chelsea [2010] EWHC 414

(Admin). This relates to another recent case, (R(B) v Cornwall County Council

[2009] EWHC 491, where a local authority blamed the service user (and his

family and carers) for missing information that should have been included in

their assessment. The High Court judge in this case stated that

The authority cannot avoid its obligation to assess needs etc by failing to

make an appropriate assessment themselves, in favour of simply requiring

the service user himself to provide evidence of his needs.




Action : Ask for your indicative budget or resource allocation (RAS) to be

reviewed if you feel it doesn‟t meet your needs or if your needs change at a

later date. It must be adequate to meet your assessed eligible needs and

should comply with Government guidance on non-residential charging.

See Age UK‟s Factsheet 46, Paying for care and support at home for further information.

3.5 Support planning, brokerage and information

The Government has advised local authorities to invest in and develop

support planning and brokerage services, making use of local voluntary-

sector and user-led organisations as part of the personalisation a agenda.

The Putting People First personalisation toolkit, published in May 2008,

advises that:

effective support planning and brokerage are crucial in enabling disabled

people to exercise more choice and control in their lives. Support planning

and brokerage, including easy access to information, advice and

advocacy, should offer disabled and older people the opportunity to make

decisions for themselves that might otherwise be made for them by other

people.

The Putting People First local government consortium advise that a support

plan should be „proportionate and non-prescriptive‟. It need not be expressed

in units of provision (like hours of care) and can include broader needs and

desired outcomes beyond then needs that made the person eligible for

support9.

9 Putting People First consortium Advice note on Personal Budgets: Council commissioned services,

January 2010, Department of Health.




Brokerage support could start at the assessment stage and run right through

to monitoring and reviewing the support. Services may vary in each area but

the aim is to allow you to get the most out of your Personal Budget.

Assistance with support planning may come from care managers,

independent support planning agencies such as voluntary organisations, or

family and friends. You should be able to choose how you wish to proceed.The Support Plan is a legal document, produced with appropriate assistance,

and owned by you.

The National Brokerage Network10 states that the scope of the broker‟s role

includes helping people to identify the changes they want to make to their

lives; find support services and community opportunities that the person

requires; negotiate with providers and prepare community resources as

necessary; cost and write a support plan; identify and obtain funding

(including securing agreement on social services funding); and initiateimplementation of the plan.

They then go on to list some other roles of a broker:

Review, prepare and/or identify indicative costs of creating and

implementing a person-centred support plan.

Assist to develop a vision of a preferred lifestyle using relevant person-

centred planning tools.

Clarify the person‟s needs and expectations as part of the care manager‟s

assessment eligibility criteria under „Fair Access to Care‟ [the means test].

Identify and apply for funding from all government and non-government

sources.

Support „Fair Access to Care‟ appeals process if required.

Identify and access community resources.

Assist with funding negotiation with commissioners.

Direct liaison and negotiation with service providers.

Monitor and evaluate provider services in conjunction with existing

monitoring and regulatory frameworks.

Modify existing provider services or develop new ones.

Mediate and resolve problems (as directed by the person).

10 http://www.nationalbrokeragenetwork.org.uk/become_a_broker.html




3.6 Ongoing support services

Providing high quality, ongoing support to people, with a range of options for

how this support is accessed and delivered, is fundamental to supporting

people to benefit from the choice and control that Personal Budgets can

bring. It is crucial that individualised support is in place from the point of self

or supported assessment onwards. Lessons learned from the provision ofDirect Payments over the past few years (in place through statute since 1996)

emphasise the importance of an effective and independent support services,

for example with payroll and other employment matters. Support services are

often provided by user-led organisations or in partnership with voluntary

organisations.

An example of this is Barnsley Metropolitan Council and a coalition of

voluntary and community sector organisations led by Age Concern

Barnsley, which are working together to develop a local support system

that enables older people to choose, manage and use a Personal Budget.

See section 2.9 regarding support services for Direct Payment users.

3.7 Personalisation and carers

The „New Deal‟ outlined in the 2008 Carers‟ Strategy has integrated andpersonalised services at its heart. The shared vision is that by 2018 carers

will:

be universally recognised and valued as being fundamental to strong

families and stable communities. Support will be tailored to meet

individuals‟ needs, enabling carers to maintain a balance between thei r

caring responsibilities and a life outside caring, whilst enabling the person

they support to be a full and equal citizen‟.

See the Information Guide entitled Advice for carers for further information on

carers‟ rights, and also see section 2.6 on Direct Payments for carers.




3.8 New approaches to service provision

Personalisation is having an effect on the commissioning of services by local

authorities. The following example illustrates this:

Redesign day opportunities

The current model of focusing day-time support in day centres and traditional home care services needs to shift to a much wider range

of options and opportunities.

Leicestershire County Council wanted to move from their current provision

of day time support for older people based around day centres, to much

broader community based support for older people assessed as eligible

for social care services. Their aim was to engage with older people using

their services, carers and the wider community to deliver their personal

goals and desired outcomes. They realised that this would mean working

in very different ways, including developing much stronger partnerships

with local communities and older people currently using day services.

They also acknowledged that this would challenge service providers to

change their current offer, to deliver a much wider range of different kinds

of support.

They identified two key steps for taking this work forward:

1) Working with current day service users to identify their goals, needs and dreams – and supporting them to become more actively involved in

their own assessments and in planning their support.

2) Using Direct Payments as the means to make the shift from older

people attending day centres to having a much broader range of options

and opportunities for support.

Discussions also took place with elected members, lead officers and staff

teams – resulting in an agreement that future day service developments must be taken forward within a wider social inclusion agenda, in order to:

Promote independence to enable older people to remain at home

after a trauma or other event in their lives

Provide support for carers with whom an older person lives to

enable them to maintain relationships and continue in their caring

role




Provide social stimulation, reduce isolation and improve general

health and wellbeing.

It was recognised that Direct Payments could offer older people greater

control and choice over the services they receive and the way these are

organised and help to stimulate the market for day time support, achieving

a greater diversity of local provision. The Local Area Agreement therefore also includes a target to increase the use of Direct Payments for older

people for recreational, leisure and educational purposes.11

4 Early intervention and prevention

Putting People First emphasises the benefits of creating a shift in resources

and culture away from intervention at the point of crisis and instead towards

prevention and early intervention, focused on promoting independence and

improved well-being and on avoiding escalation of need at a later stage. As a

result many new initiatives are being introduced locally, for example

Partnerships for Older People (POPPS) projects such as the one in Dorset12

that has been running since 2006.

An ADASS report13 in 2009 advises that a Personal Budget should only be

considered after appropriate preventative and re-ablement options have been

considered. Social care re-ablement is a short-term package of rehabilitation,usually up to six weeks, provided by local authorities, that has some

similarities with the existing system of intermediate care but appears to be

generally related to lower level or less complex needs. It may be part of the

joint commissioning arrangements of local health and social care services.

Some local authorities, such as the London Borough of Sutton, charge for re-

ablement services and others, such as Manchester and City of Westminster,

allow the first six weeks free of charge, then, after this, the service user is

charged in the same way as any other person receiving social care services.

11 Personal Budgets for older people: making it happen,January 2010 .


12 Dorset POPPS: http://www.dorsetforyou.com/popp

13 Making progress with Putting people first: Self-directed support, October 2009 , Association

of Directors of Social Services.




This is only one part of the wide range of new commissioning

developments within the personalisation agenda aimed at meeting care

and support and wider needs of all those living in the community. This

Factsheet is not intended to cover all of the initiatives that are taking

place.

Note: Re-ablement may be charged for but NHS intermediate care shouldalways be free of charge.

5 Risk management and safeguarding

The Government is working to re-design the health and social care regulatory

systems in light of the shift towards more personalised services and self-

directed support. The Better Regulation programme is looking at risk and

responsibility in public services. Personalisation requires new, more flexible

approaches to regulation and risk management, which are able to adapt to

innovative support solutions from new types of providers.

There is an ongoing debate between Government, service providers and

service users about the appropriateness of certain types of regulation, for

example for personal assistants, and regarding safeguarding vulnerable

adults. Those employed directly by Personal Budget holders as personal

assistants do not currently require a Criminal Records Bureau check.However, those receiving Direct Payments on behalf of someone else, for

example if they lack capacity, and who are not a family member or friend,

must carry out a Criminal Records Bureau check on anyone they employ.

In its 2008 report Raising voices: views on safeguarding adults, the

Commission for Social Care Inspection (now the Care Quality Commission)

recognised that:

it is important not to be over-protective or prevent adults from leading

ordinary lives – but this must be weighed against individuals‟ fundamental

right to expect to be safe and to be protected and safeguarded from harm.

The report emphasised the need for clarity of roles and responsibilities of the

agencies involved in safeguarding adults (within social care and wider public

services) with clearer definitions of what constitutes abuse and harm.




The Department of Health‟s 2007 report Independence, choice and risk: a

guide to best practice in supported decision-making recognises the

complexities involved in managing risk in relation to choice but is clear that:

ultimately, the local authority has a statutory duty of care and a

responsibility not to agree to support a care plan if there are serious

concerns that it will not meet an individual‟s needs or if it places anindividual in a dangerous situation.

For further information about safeguarding and abuse see Age UK‟s

Factsheet 78, Safeguarding older people from abuse .

6 Complaining about a decision

You have the right to use the local authority complaints procedure if youdisagree with any decision about Direct Payments or Personal Budgets. Each

local authority must publish details of its complaints procedure and you

should be told about it. A new joint health and social care complaints

procedure was introduced in April 2009, replacing the existing three-stage

local authority system.

See Age UK‟s Factsheet 59, How to resolve problems and make a complaint

to the local authority , for further information on complaints and your rights to

social services.

7 Useful organisations

Assist UK

A national organisation of Disabled Living Centres throughout the UK.

Tel: 0870 770 2866Textphone: 0870 770 5813

Website: www.assist-uk.org




Care Quality Commission (The)

The independent regulator of adult health and social care services in

England, whether provided by the NHS, local authorities, private companies

or voluntary organisations. Also protects the rights of people detained under

the Mental Health Act.

Tel: 0300 0616 161 (free call)

Website: www.cqc.org.uk/

Carers UK

General help and advice for all carers.

Tel: 0808 808 7777 (free call)

Website: www.carersuk.org.

National Centre for Independent Living

An organisation run by and for disabled people working on campaigns and

policy. It provides a wide range of publications relating to Personal Budgets,

Direct Payments and personal assistance. It also offers training and

consultancy on Direct Payments and personal assistance.

Tel: 020 7587 1663

Website: www.ncil.org.uk.

New Employers’ Helpline

Helpline from the HMRC providing information to those considering becoming

employers.

Tel: 0845 607 0143

Website: www.hmrc.gov.uk.

Royal Association for Disability and Rehabilitation (RADAR)

A campaigning organisation that also provides various guides.

Tel: 020 7566 0116

Textphone: 020 7250 4119

Website: www.radar.org.uk




Further information about Personal Budgets can be obtained from the

following websites:

In-Control www.in-control.org.uk/

A leading organisation in the development of self-directed support; provides a

wide range of services assisting in the continued development of the newpolicy. (See Appendix, no. 6)

CSIP

Care Services Improvement Partnership‟s individual budget pilot programme:

http://individualbudgets.csip.org.uk/index

Department of Health

Information on individual budgets can be found in the social care section of

the Department of Health website at:

www.dh.gov.uk/en/SocialCare/index.htm.jsp

8 Appendix

1/ Putting People First is a shared commitment between five government

departments, local government, the professional leadership of adult social

care and the NHS, and the regulatory bodies. It is designed to transform

social care services by making significant changes to the existing system. 2/ A further Local Authority Circular entitled Transforming adult social care

was published on 5 March 2009.

3/ Personal or individual budgets have been mentioned in several recent

Government policy publications including Independence, well-being and

choice (DoH 2005) and Our health, our care, our say (DoH 2006). The

culmination of this was the Government „concordat‟ Putting people first – a

shared vision and commitment to the transformation of adult social care

(DoH 2007).




4/ Personal Budgets are derived from the positive outcomes that adult

service users have achieved as a result of Direct Payments; also from the

work carried out in the In Control pilot scheme for adults with learning

disabilities, which began in 2003. The In Control pilot provided evidence of

the increased satisfaction levels of service users as a result of the

introduction of self-directed support. One of its aims was to eradicate someof the problems encountered by users of Direct Payments. The outcome

was the design of a new process, which has been used as a model for the

introduction of their Personal Budget programmes by many local

authorities.

5/ The Social Care Reform Grant, announced in Putting People First , is

available to local authorities to support universal information, advice,

advocacy, support planning and brokerage services to be developed locally.

6/ The rule making Direct Payments the only legal way that local authorities

can make cash payments to an individual is complicated by the fact that

local authority‟s can make payments to individuals under section 2(1) of the

Local Government Act 2000, which gives them a general power (discretion)

to promote the wellbeing of the area. Section 2(2)(b) of the 2000 Act states

that this power may be exercised in relation to “all or any person resident or

present in a local authority‟s area”, and section 2(4) gives a list of the types

of actions the local authority can take, including 2(4)(b), where it can “give

financial assistance to any person”. Whilst such payments would nottechnically be Direct Payments, Essex County Council and possibly others

have been making their Direct Payments under section 2(1) of the 2000

Act . The present Law Commission review of adult social care is looking at

this issue and proposes clarifying that if a payment is made in order to meet

assessed needs it should be made under directs payments legislation.

However, section 2 of the 2000 Act could still be used to provide

preventative services.

9 Further reading

A Guide to receiving direct payments from local council, a route to

independent living. September 2009. Available free from Department of

Health. Tel: 0870 1555455, fax: 01623 724524.




Community Care (Direct Payments) Act 1996 . Price £6.00. Available from The

Stationery Office. Tel: 0870 600 5522. Free from the website:

www.opsi.gov.uk.

Direct routes to independence: a guide to local authority implementation and

management of direct payments . Policy Studies Institute. Price £10 (p&p 20%

of order value to a maximum of £10) (ISBN: 0853 74 75 71). Available fromCentral Books. Tel: 020 8525 8840.

Employed or self-employed? A guide to employment status for tax and

national insurance . (Ref: IR56). Available free from HM Revenue & Customs

Office (formerly „Inland Revenue Enquiry Centres‟). Orderline 0845 9000 404

Website: www.inland revenue.gov.uk.

Helpful employment guidance can be found on www.direct.gov.uk and

www.businessink.gov.uk.

10 Further information from Age UK

Visit the Age UK website, www.ageuk.org.uk, or call Age UK Advice free on

0800 169 65 65 if you would like:

to order copies of any of our information materials mentioned in this factsheet

to request information in large print and audio

further information about our full range of information products

contact details for your nearest local Age UK/Age Concern.

Books from Age UK

We publish a wide range of books for older people and those who care for

and work with them. The following title may be of particular interest:

Your rights to money benefits 2010 –2011

All you need to know about the full range of benefits available in retirement.

£5.99

To order this book visit www.ageuk.org.uk/bookshop or to request a free

books catalogue please call our book order line 0870 44 22 120 (lo-call rate).

http://www.direct.gov.uk/

http://www.direct.gov.uk/




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Age UK is the new force combining Age Concern and Help the Aged. We

provide advice and information for people in later life through our,

publications, online or by calling Age UK Advice.

Age UK Advice: 0800 169 65 65Website: www.ageuk.org.uk

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Website: www.agecymru.org.uk

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Website: www.agescotland.org.uk

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Age NI: 0808 808 7575

Website: www.ageni.org.uk

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FS24 Self-Directed Support Direct Payments and Personal Budgets August 2010 Fcs

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Transcript of FS24 Self-Directed Support Direct Payments and Personal Budgets August 2010 Fcs