Living Independently
Direct payments
Direct payments
This is a cash payment that is given to a disabled person in place of direct community care provided by social services. The payment is intended to provide greater flexibility in the delivery of community care services as it allows the individual to make the decision on how, when and by whom their personal care is delivered. A direct payment may not be used to purchase residential care.
Direct payments are available to disabled people over the age of 18 who meet the eligibility criteria.
What are Direct Payments?
A direct payment is a cash payment given to disabled people. It replaces any direct community care service that would have been provided by their local Social Services Department.
How did Direct Payments evolve?
In 1996, legislation called the Community Care (Direct Payments) Act was passed. Since its implementation in April 1997 (and with the passing of additional legislation), local authorities have been able to offer grants or payment as an alternative to providing a care in the community service to those eligible.
What is the purpose of providing a Direct Payment?
The aim is to provide greater flexibility in how community care services are delivered. Giving a cash payment to the individual - as an alternative to a service that the local authority would have controlled and provided - gives greater autonomy. They can then make their own choices about how, when and who delivers their personal care. The government believes Direct Payments help people who want to manage their own support and improve the quality of their lives. Such payments promote independence, choice and inclusion by enabling people to purchase the assistance or services they need to live in their own home and local community, and to access work, education and leisure facilities. The management of a care package is therefore given to the person with the strongest incentive to spend it wisely and who has the best understanding of how to match their own individual needs.
Who can receive one?
Direct Payments are available to those who are disabled, aged 18 years and over and who meet the Eligibility Criteria (see other areas of this web site) for a service. They are also available for parents of children with a disability and other carers, if their own needs meet the criteria.
Direct Payments were extended to young people with a disability aged 16 and 17 years under the Carers and Disabled Children Act 2000.
The local authority has a duty to offer a Direct Payment in lieu of a service, but each individual can still elect to receive their local authority's own packages of care if prefered. It is also possible to have a part Direct Payment, utilising a mix of care with some services coming directly from the Social Services Department and some being secured through a Direct Payment. It is simply a matter of choice.
Who makes the payment?
The local authority Social Services Department is responsible for payment. They will work out what it would reasonably cost on a weekly basis to purchase the care for which an individual has been assessed and then award that payment.
What can the payment be spent upon?
Whilst it has to be spent on providing the care and support in the community, an individual's needs requirement assessment. The payment can be used in whatever flexible manner that person wishes. For example, it can be used to employ a personal assistant to provide personal care. It could also be used for transport, attending leisure pursuits and work, alternatives to a day service or taking a short term break. The payment is designed to offer flexibility, therefore the payment changes as the individual's needs change.
A Direct Payment cannot be used to purchase residential care.
Rules and responsibilities surrounding the receiving of a Direct Payment
Some of the basic rules are: -
- The payment has to be spent on the individual's assessed needs
- The money received must be paid to a separate and dedicated bank account
- Simple records must be kept to show how payments have been spent
- An individual's own family cannot be employed to provide assistance (save in very exceptional circumstances)
- There must be a formal agreement to use a Direct Payment scheme
Some of the responsibilities are: - - Each individual will need to recruit and employ their own carers or make other arrangements - see later comments
- The individual needs to be a reasonable employer who gives their staff a job description, contract of employment and does not put them at risk of injury
- Appropriate insurance must be attained for employing people
- There may be a need to consult with the Inland Revenue office regarding tax and National Insurance deductions for people employed
- People employed to support and care for young people with a disability, aged 16 or 17 years, will require a police check from the Criminal Records Bureau
Alternatives to having the responsibilities of employing your own staff
No matter what independence and flexibility advantages Direct Payments can provide, it can sometimes be daunting to take on the responsibilities of being an employer. If this is the case then one viable alternative is to use a care agency and their staff using Direct Payment to purchase this service. In this way some personal autonomy is still retained over the service received.
Alternatively, assistance can be sought from a Direct Payments scheme. Whilst these may feature under a particular local name, it is often a name similar to 'Independent Living Scheme'. These schemes are set up to provide specific advice and support to those people wishing to establish control over their own packages of care and utilise Direct Payments.
The sort of support these schemes can provide includes:-
- Recruitment of personal assistants
- Help with adverts and job descriptions
- Expertise regarding contracts of employment and employment legislation
- Advice on how to best safeguard and protect oneself as a potentially vulnerable person when employing staff
- Payroll services for staff
Recently, the government has provided an extra £9 million to encourage the wider use of Direct Payments by using such schemes.
Direct Payments and people with a learning disability
Choice is one of the major tenets of the government policy, 'Valuing People' (2001). Choice can be made easier with the use of a Direct Payment.
Part of the criteria and guidance for getting a Direct Payment is 'a person must be willing and able to manage their Direct Payment'. This should not be seen as a barrier for people with a learning disability, as the ability to consent is not necessarily the same as the ability to manage. The guidance from the Department of Health clearly states that a person can receive as much assistance as they require in order to manage a Direct Payment.
There is a general concern from the government about how few Direct Payments have been claimed overall. In 2003 in England, there were fewer than 10,000 people receiving Direct Payments. By 2004, this was up to around 13,000. All this in a context where £10bn is spent on caring for many hundreds of thousands of people. There are concerns about numbers in general and there are likely to be very few Direct Payments going to those people with a learning disability. Based on the 2003 figures, the government believes only one in every 100 Direct Payments went to a person with a learning disability.
The Values into Action group research into peer support for people with learning disabilities found there were very few independent Direct Payment support schemes run solely for people with a learning disability. Where a reportedly good support scheme existed, this served a wider group of people and they supported either no or a minimal number of learning disabled people in their scheme.
Values into Action also states that people with a learning disability need the same support as other people who want to utilise a Direct Payment. However this support needs to be provided in different ways. Mainstream written information may clearly not be so useful and different time scales may have to be adopted to enable appropriate explanations and decision-making to take place. There are other assumptions around 'consent and ability' which may need to be worked through. There may, for instance be resistance from others who question the competence of the individual to direct what they want from their care package or Direct Payment. Competence and being 'able' in this context are about a person's ability to choose and know what they want from their lifestyle. The 'ability test' is not whether a person can necessarily manage the administrative processes which supports a Direct Payment, as this can be facilitated by others.
One feature, which may have hindered the progress of people with a learning disability taking up Direct Payments, has been problems with banking services and setting up appropriate bank accounts to receive payments. The Government has promised to approach the British Bankers Association to see how some of these problems can be resolved. The Valuing People Support Team has some information about this issue, which can be found at their website www.valuingpeople.gov.uk
On the question of banking, ultimately it is considered that people with a learning disability cannot be treated differently from the way any other person would be with the same set of circumstances, as this would contravene the Disability Discrimination Act. The question, in the first instance, is whether the person understands what the bank account is for and, if so, then what support and safeguards do they need to operate it.
To support the promotion of Direct Payments, the Department of Health has commissioned some guidelines and advice which are more accessible for people who have a learning disability. 'An Easy Guide to Direct Payments - Giving you the Choice and Control' was developed with the help of Swindon People First and Real Voice Media. It is part of a book, tape and CD Rom pack - details can be found on the DOH website: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4097396
Values into Action (V.I.A.) also has books, leaflets and videos about Direct Payments. Its address is V.I.A., Oxford House, Derbyshire Street, London E2 6HG. Tel: 020 7729 5436. www.viauk.org
The National Centre for Independent Living website is designed to be a resource on independent living and Direct Payments and can be found at http://www.ncil.org.uk/
