Direct payments are a way of giving older people more control over the way their care needs are met. Rather than the local authority social services department providing or arranging the community care services which have been assessed as needed, the authority can provide money to allow people to arrange their own services.
Local authorities have to offer you the option of direct payments if you meet certain criteria. Guidance issued by the Department of Health sets out how local authorities should develop and administer their direct payment schemes.
Direct payments can be used to arrange most community care services provided by the local authority except for long term residential care. You can choose to have some of your services provided or arranged by social services, and use a direct payment to arrange the rest for yourself. Services can also include equipment such as aids 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 which social services has assessed you as needing.
They cannot be offered to people who are assessed as not needing any services, or as a way of meeting needs that social services are not prepared to meet. Each local authority has devised its own ‘eligibility criteria’ to decide who can get services, which should be published. 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.
The guidance instructs councils to be prepared to look beyond their own existing models of patterns of service provision when considering whether a person’s need for services will be met by the arrangements being proposed. Service users should be encouraged to explore innovative and creative options where these will meet their needs more effectively.
You may be asked to contribute towards the cost of your care services. Your contribution is calculated using the same rules as if the local authority were providing or arranging services.
The Government plans to introduce ‘individual budgets’, intended to give service users greater control over the care they receive. Local authorities will tell service users how much money is available for their care and support and the service users will be able to choose how they want their needs to be met. This could involve a cash payment, like Direct Payments, asking the council to provide services up to that cost, or a mixture of these. Individual budgets are currently being piloted in 13 local authority areas. Results from these pilot schemes are expected in 2008 and will be used to identify how individual budgets might be rolled out nationally.
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;
•not subject to certain mental health or criminal justice legislation which carry elements of compulsion;
•willing to have a direct payment; and able to manage a direct payment (alone or with assistance).
Local authorities are required to offer direct payments to all service users who meet the eligibility rules set out above. The Government has proposed that Direct Payments should, in some circumstances, be made available to people who cannot manage their own care, even with support. Instead an agent will be appointed to manage the payment. This will require changes to the law and is unlikely to be implemented before March 2008.
Local authorities must satisfy themselves that their direct payment schemes serve all adult client groups and do not discriminate unfairly between people requesting direct payments. The council should seek and respond to service users’ views on an ongoing basis.
How to get a direct payment
If you currently receive services, you may wish to switch to direct payments rather than continue to have services arranged or provided by the local authority. Contact the social services department which organises your care to obtain further details of direct payments. The possibility of a direct payment may come up during a review of your care package.
If you do not currently receive a direct payment or have services arranged or provided for you, ask the local authority to carry out an assessment of your needs.
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 meantime. You may need to have services arranged by the social services department until you are able to put your own services into place.
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.
Arranging your own services
With Direct Payments you can arrange your own services for:
•employing your own care workers;
•contracting with an agency or someone who is self-employed;
buying your own equipment;
•dealing with emergencies.
Employing your own care workers
This option gives you the greatest choice and control over your care services. For some people the thought of being an employer may cause worries as it also carries more responsibilities. Many people who receive direct payments already have found it to be a successful way of arranging their services, and once systems have been set up, find that they run smoothly.
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.
If you decide to use an independent care agency you should be able to find local agencies in the telephone directory, your local authority might be able to provide names of agencies in your area, or you may be recommended an agency by word of mouth.
Buying equipment
Direct payments can be used to buy equipment or adaptations that would otherwise have been provided by social services departments. 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. Direct payments may be more appropriate for smaller pieces of equipment rather than complex, expensive items.
Dealing with emergencies
Whatever the arrangements you make, there may be times when they break down. Discuss your contingency plans with social services so that they are included as part of the care plan for your direct payment. If you employ your own care worker, your contingency plans might include making arrangements with an independent agency for emergency cover. Some support schemes offer back-up in the form of emergency staff.
The social services department’s responsibility for arranging services is the same as for any other service user. If the local authority becomes aware that your assessed needs are not being met, it has a duty to act to resolve the problem. You should have a named person to contact to ask for help.
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