Section 1 - Receiving a direct payment

1. Policy Statement and Legal Framework

Neath Port Talbot Council (‘the Council’) is committed to ensuring that all people with an assessed eligible care and support need receive high quality, sustainable and personalised responses to meet that need and help them to achieve their agreed personal outcomes.

Direct Payments are payments of money made to individuals to use to meet some or all of their eligible care and support needs. This can increase a person’s independence and choice by providing them with control over the ways in which their assessed needs are met and/or enable carers to continue in their caring role.

The purpose of this policy, and the accompanying Guidance document, is to meet the Council’s statutory obligations and to provide a framework for the use of Direct Payments.

The policy applies to adults and carers aged 16 or over, who have been assessed as eligible to receive support under the Social Services and Well-being (Wales) Act 2014 (‘the Act’).

The Act, together with Regulations made and Codes of Practice and Guidance issued under it, is the legislative framework that sets out the Council’s duties to meet an individual’s need for care and support, or support in the case of a carer, following an assessment. The Council will have a duty to meet that need if the need meets statutory eligibility criteria and cannot be met by the person’s own resources or community resources.

2. Eligibility Criteria – who can receive Direct Payments?

Direct Payments must be offered by the Council as a way of meeting some or all of a person’s assessed needs if:

• The Council considers that direct payments are an appropriate way of meeting the needs, and
• The person is capable of managing the payments, either alone or with support, or if the person lacks capacity to manage their affairs, a suitable person will do so on their behalf.

A person does not have to agree to receive direct payments and can ask to have a service provided instead. A Direct Payment can be a single payment for a specific service or item or may continue for ongoing eligible needs.
Examples of people who may be eligible for a Direct Payment include:

• People with disabilities aged 16 and over, including those with physical and learning disabilities and sensory impairments
• Adults who meet the eligibility criteria in accordance with the Act
• Adults, including people who are entitled to after care in accordance with Section 117 of the Mental Health Act 1983, if they are not subject to certain exemptions
• Adults with parental responsibility for disabled children in order to meet the disabled child’s needs
• Young carers and adult carers providing regular and substantial care
• People who are subject to drugs and alcohol-related provisions of certain criminal justice legislation, but only on condition that payment is made to another person who is suitable and both persons agree to the arrangement.

There are a number of conditions for the provision of Direct Payments:

• The person must agree to use the funds only to secure services to meet their eligible needs and outcomes as determined by the assessment and set out in the Care and Support Plan
• The Council must assess whether a person must pay a contribution towards the cost of the care and support they need, whether that need is to be met by the provision of services or through Direct Payments. Only the net amount of the Direct Payment will be paid following the outcome of the financial assessment. The person will be required to pay any assessed contribution into the Direct Payment account in line with the Council’s Residential and Non-residential Care Charging Policy
• The Direct Payment will be regularly reviewed to ensure the care being provided is in accordance with assessed needs, and adjustments may be made to the amount of the Direct Payment as required.
• The Council will not be liable for any costs or liabilities incurred because of an individual’s failure to pay their contribution into the Direct Payments account

Those eligible will be offered Direct Payments, although there are exemptions. Direct Payments will not be offered to people who, following assessment, would not be offered services in any circumstances. Individuals who are eligible, but decide not to take up Direct Payments, will have commissioned services arranged on their behalf.
Direct Payments may be refused to people who have been placed under certain conditions or requirements by the courts. These include:

• Any offenders subject to a community order, a community rehabilitation order, or a community punishment order and rehabilitation order, which include a requirement to accept treatment for drug or alcohol dependency
• Offenders released from prison on licence subject to an additional requirement to undergo treatment for drug or alcohol dependency

3. Direct Payments for Adults Lacking Capacity to Consent

In cases where the person in need of care and support is assessed as lacking capacity, as defined in the Mental Capacity Act 2005 (‘the MCA’), to request Direct Payments, a Suitable Person can request the Direct Payment on the individual’s behalf.

A Suitable Person is someone appointed to receive and manage Direct Payments on behalf of an individual who lacks capacity to consent to the making and receiving of the Direct Payments (provided that person is willing and meets all the conditions set out in the Regulations). 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 Section 16 of the MCA. Usually the Suitable Person will be a family member or friend who may previously have been involved in the care and support of the individual.

In these cases, before authorising a Direct Payment, the Council must satisfy itself that:

• It is not prohibited from meeting the individual’s needs by making Direct Payments to the Suitable Person
• The Suitable Person will act in the individual’s best interests in arranging for the provision of the care and support for which the Direct Payments would be used
• The Suitable Person is capable of managing the Direct Payment either independently or with support
• Making Direct Payments to the Suitable Person is an appropriate way of meeting needs

If there is no representative, then the Council itself must make the decision about whether or not someone should act as a Suitable Person to manage the payments on behalf of the person who cannot consent. This will be determined through a Best Interest Assessment meeting.

To protect the interests of people lacking capacity, the Council will require that the Suitable Person will be subject to a satisfactory Disclosure and Barring Service (DBS) check (see also ‘Safeguarding’ below).

4. Transition

The Council has clear obligations regarding children and to make sure that Adult Services and Children and Young People Services (CYPS) cooperate to anticipate and support the transition of a young disabled person into adulthood. The guiding principle is that the welfare of the child is paramount.

A young person aged 16 or 17 can receive Direct Payments if they are assessed by the Council as being eligible. Direct Payments are given to 16 and 17 year old disabled children directly rather than to their parents or carers. The young person can then decide which services to use. This only applies if the young person is considered “competent” to organise their own care.

In determining whether the young person will be eligible for adult social care provision upon reaching the age of 18, Adult Services will need to complete a full assessment with the young person to identify the well-being outcomes and relevant care and support or assistance required to enable them to live their life as independently as possible. When the young person turns 18 they will also receive benefits in their own right, which means they will be required to declare their financial circumstances and be assessed to make a financial contribution.

Continuing a Direct Payment after childhood will be dependent on the individual and the identified well-being outcomes discussed in partnership during the transition process. The Direct Payment may reduce, increase or end but the family and the person themselves will be kept updated and informed during the process and provided with relevant support.

If people with parental responsibility are going to continue in their caring role after the young person becomes 18 then such carers may be entitled to receive Direct Payments as an alternative to carers’ services.

There may be situations where a parent has been receiving Direct Payments to meet the well-being outcomes of their child who, on reaching the age of 18, does not have the requisite mental capacity to consent to the making of those Direct Payments. In such cases, it will often be appropriate for the person with parental responsibility to continue to receive the Direct Payments for the young adult lacking capacity, in the role of a Suitable Person (see 3 above). This will ensure continuity of care for the young adult, and ensure that the payments are managed by the person who is likely to be best placed to understand the individual’s needs and preferences.

5. Financial Assessment

The Council will carry out a financial assessment under Part 5 of the Code of Practice with the person or their financial representative to establish how much, if anything, a person has to contribute towards their Direct Payment.

The Council will make a monetary payment into the Direct Payments account based on the client’s assessed eligible needs and the completion of a Care and Support Plan.

Recipients will be paid net of any assessed charges. As such, individuals must ensure their contribution is paid directly into the Direct Payments account and will be included in the calculation for the overall total of a Direct Payment. Failure to pay this contribution will lead to insufficient funds being available to pay any responsibilities associated with the Direct Payment, e.g. wages, tax bills or payroll fees. Any contribution payable will be reviewed on an annual basis (or following a change in financial circumstances) and as such may be recalculated.

The principle of Direct Payments is that an individual manages their payments to buy care and support to meet their needs. The Council will not be liable for any costs and liabilities incurred because of an individual’s failure to pay their contribution into the Direct Payments account or to manage their payments properly.

6. Reasonable Funding and Personal Top Up

The total amount of a Direct Payment will depend on the person’s assessed need, but will not exceed what is considered reasonable for the person to have to pay to secure the relevant service(s). The Council has a duty to make adequate arrangements to meet the person’s assessed needs but is not obliged to fund additional costs associated with the person’s preferred method of securing the service or cost incurred by the person.

If a Direct Payment recipient chooses to secure services that are more expensive than the amount received as a Direct Payment, then the individual will need to make a payment from their personal funds for the difference in cost (see Fairness of Service Provision Policy).

The money is held by the Direct Payment recipient as a means of paying for their social care needs. It is not their personal money or welfare benefit, and they will be required to provide evidence that it has been used properly to meet their assessed needs.

7. How will I receive my Direct Payment

There are a number of ways in which funds can be received and the Direct Payments Support Service (DPSS) will be able to offer advice and guidance on the most appropriate for the individual concerned.

Prepaid Card

This is an alternative to a bank account and looks similar to a debit card. Funds are preloaded onto the card by the Council and the person (where they have been assessed to make a financial contribution towards support). When the funds are transferred onto the Prepaid Card they are available to use instantly.

The card can be used to pay for care and support to meet needs as agreed in the support plan up to the value that is loaded onto the card.

The person can view spend activity online and this information is retained and available to print as needed. The client can upload documents, e.g. receipts, and there is no need to send the Council statements regularly, as the Council can access the information online. Using a pre-paid card will therefore reduce the financial monitoring requirements of the client.

Directly to a Bank Account

This is where money is paid into a high street bank account. This can be an account for the individual or the person who represents them, but it must be a separate account from their normal bank account to clearly show the money being spent on care and support.

Using this method the person must retain the bank account statements and receipts and submit these on request as evidence of the spending on care and support needs. Submission of these documents is usually quarterly and is set out in the agreement signed by the Direct Payment recipient.

Managed Account

A Managed Account Service is a way to get additional help and support for recipients to administer their Direct Payments. Direct Payments are made to a commissioned payroll provider service which manages the funds on their behalf, but the recipient or Suitable Person remains responsible for how Direct Payments are used. For example, if Direct Payments are used to employ staff the recipient / Suitable Person is the employer, and (s)he must ensure that staff are properly trained for their role, e.g. in manual handling, and that this is kept up to date. The payroll provider will carry out payroll functions such as tax, National Insurance and pensions on a day to day basis. The DPSS will be able to offer advice and guidance on this.