Personal Budgets and Direct Payments

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

A personal budget can be used for:

• Employing a personal assistant (PA) or for purchasing care and support services:
• Buying specialist equipment where there is an assessed need;
• Paying for leisure or educational activities and transport costs.

Direct payments are monetary payments made to assist with meeting a child or young person’s assessed need by the Local Authority to fund part or all services as an alternative to commissioned services. Local authorities must offer the option of Direct Payments in place of services currently being received. For both education and social care, the local authority/practitioner must be satisfied that the parent, nominated person or young person (who is over the age of 16):

• Is able to manage the Direct Payments independently or by the SAP (Suitably Appointed Person), Nominee or Parent/Carer or person with parental responsibility for the child.
• Is the most appropriate way of arranging the required support or services rather than commissioned services from the relevant body;
• Will use the direct payment in an appropriate way to meet the needs of the child/young person and will act in the best interests of the child or young person.

Direct payments for education are monetary payments to parents of a child with an Education, Health and Care Plan (EHCP) and should be specified in the EHCP. These include requirements to consider the impact on other service users, taking account of value for money and to seek agreement from educational establishment where a service funded by a Direct Payment is delivered on their premises.

Direct Payments for health require the agreement of a Care Plan between the Integrated Care Board (ICB) and the recipient.  Direct payments and Personal Budgets also apply to young people who require Aftercare services under section 117 of the Mental Health Act 1983, children and young people receiving Continuing Health Care funding and people eligible for an NHS wheelchair (personal wheelchair budgets).

The Children and Families Act 2014 gives parents and carers of children with Education, Health and Care Plans; and young people over the age of 16, greater choice and control over the support arrangements. If a child or young person receives an Education, Health and Care Plan they will be able to ask for a personal budget, part of which might be available through a direct payment.

A Personal budget for a child or young person with an EHC Plan could be managed:

• Through a direct payment;
• By the Local Authority or school on their behalf.

Examples where families may need to access additional support for their child are:

• Additional support from Education to ensure that a child's learning needs are met. This could include home to school transport, specialist equipment or types of therapy, and would make up a personal SEND budget with a focus on learning outcomes;
• Additional support from the Health Service where a child has a complex long-term and/or life-limiting condition. This would make up a personal health budget focused on health outcomes;
• Additional support from Social Care where a child needs additional support at home or where a family need a short break from caring. This would make up a personal care budget focused on outcomes around family and home life, being safe when out and about in the local community and being able to take part in life outside of school.

All the above are examples of items that are over and above those that a provider (e.g. school) is expected to provide as part of their local offer and together would form the child or young person's overall personal budget. The key area of change arising from the SEND reforms is that instead of a family being provided with these services by the LA, school or Health Service, a single budget is identified and work takes place to plan how this can best be used to meet the child or family's needs and to improve learning outcomes.

The Department for Education has also stated that Local Authorities should extend choice and control, through a personal budget, so that parents of children with an EHC Plan can have a greater say in the way in which services can be delivered. This is currently been considered by colleagues in Education Services.

Regulations governing the use of Direct Payments for special educational provision place a number of additional requirements on both local authorities and parents before a Direct Payment can be agreed. These include requirements to consider the impact on other service users and value for money and to seek agreement from educational establishments where a service funded by a Direct Payment is delivered on their premises.

Direct Payments for health require the agreement of a Care Plan between the Integrated Care Board and the recipient. These payments are usually arranged by the local authority on behalf of the ICB.

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

Direct payments are given to 16- and 17-year old disabled young people 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 able to organise their own care and support. 

Direct Payments can only be provided to a person with parental responsibility for a child who is entitled to an assessed care package from the Local Authority.

A person with parental responsibility for a disabled child aged under 16:

• This includes parents who hold parental responsibility and others who have acquired parental responsibility for a child, usually via a court order;
  OR
• Parents and people with legal parental responsibility and who are not necessarily the child's parents.

Direct Payments cannot be used to pay for services from a spouse, partner or a close relative living in the household unless the local authority consider it is necessary to do so. However, direct payments can be used to employ a relative if they are not living in the household.

Direct Payments are usually paid in arrears into a designated bank account, usually a direct payments card account specifically set up for this purpose, this money is paid every 4 weeks. If the direct payment is assessed as being needed at key times e.g. school holidays, then payment will be made accordingly.

The arrangements for Direct Payments will be included in the child's/young person's care and support plan Education, Health and Care Plan, following an Education, Health and Care Needs Assessment. See Children and Young People Aged 0-25 with Special Educational Needs and Disabilities Procedure.

• To pay for the support to take the young person/child into the community to access an activity, support inclusion, going to a club etc.
• To support the child directly within the home, to give parents and siblings a break;
• To stay overnight to give respite to parents;
• Or to pay for support of a registered childminder or child home carer (for children aged under 8).

When a child or young person under 16 years needs to go into hospital, the parent, carer or the person managing the Direct Payment, should advise the local authority straight away to discuss the continuation of the payment.

It is possible that the payment will continue for a time-limited period, if only to allow for the person managing the Direct Payment to ensure that any contractual obligations around termination of the support can be met. However, there might also an issue of continuity of care post-discharge to consider in some instances. Suspending the payment could result in the person having to break the employment contract with a personal assistant which may not be appropriate. Contact should be made with the Direct Payments Team for advice on these occasions.

Where a parent or young person is in receipt of Direct Payments, hospitalisation may not necessarily mean that the Direct Payments should cease. Guidance advises that consideration should be given by the local authority, the carer, the holder and the ICB as to how the payments might be used to meet non-health needs or to ensure that the employment arrangements can be maintained. For example, the holder may prefer some personal care tasks to be undertaken by the carer rather than hospital staff. However, the personal care and medical input need to be tailored so as not to interfere with the medical treatment. (Terminating or suspending the carer's employment may lead to a delay of continuity of care and a delay in discharge).

In instances where the recipient nominated person requires hospital treatment, the local authority must conduct an urgent review to ensure the holder continues to receive the care and support they need. This might include the duties to be carried out by a temporary nominated person, or through short-term authority arranged care/support.

• Employing someone without Disclosure and Barring Service checks or references, or someone subject to a drug or alcohol treatment requirement, youth rehabilitation order or released on licence.

Direct Payments cannot be provided for the purchase of long term residential care.

• In most cases residential respite care will be a directly commissioned service but there may be some circumstances where it is appropriately purchased using Direct Payments. There are however specific conditions that apply (see Care and Support Guidance and Direct Payments Regulations 2014). In order to purchase residential care with Direct Payments, short-term care in a care home must not exceed 4 consecutive weeks or, where the period between stays is less than 4 weeks, the cumulative total over this period must not exceed 4 weeks. This does not affect purchasing rolling respite through the year which might exceed 4 weeks but is taken in individual periods which do not exceed the limit and with sufficient breaks in between.

Direct Payments allow parents of disabled children and young people greater choice flexibility and control, to employ their own workers at times convenient to them and in the way they wish, to provide an individual service to meet their needs. Payments made do not affect welfare benefits as they are not classed as income.

Where the local authority decides not to make Direct Payments it must inform in writing the child's parent or the young person of its decision and reasons in a format that is accessible to them and in line with the Data Protection Act. It must also advise of their right to request a review of the decision. Alternative services must be offered

The local authority must monitor and review the use of Direct Payments by the recipient at least once within the first three months of Direct Payments being made, and when conducting a review or a re-assessment of the child, young person's care and support plan or the Education, Health and Care Plan.

AUDITING DIRECT PAYMENTS

• The Direct Payments agreement includes a requirement for the recipient to provide relevant information in order for an audit to be completed. Using payment cards helps make the process easier but there is still a requirement for the recipient to provide information;
• An initial review of Direct Payments is completed between 3-6 months; audits will then be completed annually after this if the Direct Payments are stable and well managed. If there are any concerns relating to the management of the Direct Payments or their use, then more frequent auditing may be required if agreed by the Senior Finance Officer or Direct Payments Team Manager. The case worker or another member of the assessing team should be informed of any concerns. It is important that auditing in these cases remains proportionate, if after a period of time concerns no longer persist then it may be appropriate to reduce the frequency of audit with the agreement of the Senior Finance Officer, Direct Payments Team Manager, case worker and responsible Team Manager;
• An audit is always required if misuse of Direct Payments is suspected, close communication and liaison with the assessing team will be required from the outset;
• If there is evidence of Direct Payments being misused or if the recipient has failed to comply with the audit, the responsible Team Manager, in consultation with the Direct Payments Team Manager should consider whether the Direct Payments can continue or should be terminated (or suspended pending further investigation). It may be that a review/reassessment is required which should be completed as soon as practicably possible, a decision should not be delayed unnecessarily.

A person's ability to manage Direct Payments over time may change, as might their circumstances. Assessors must be satisfied that Direct Payments are, and will continue to be, used appropriately to meet assessed eligible need as intended. If it is identified through the process of monitoring and review that this is not the case, or that the parent or young person is struggling to manage, then a full reassessment will be required.

When carrying out a review, the local authority must consider whether:

• It should continue to secure the agreed provision by means of Direct Payments;
• The Direct Payments have been used effectively;
• The amount of direct payments continues to be sufficient to secure the agreed provision;
• The recipient has complied with their obligations on the use of the Direct Payment.

Following a review the local authority may:

• Substitute the person receiving the Direct Payments with a nominee, the child's parent or the young person, as appropriate;
• Increase, maintain or reduce the amount of Direct Payments;
• Require the recipient to comply with either or both of the following conditions:
  • Not to secure a service from a particular person;
  • To provide such information as the local authority considers necessary.
• Stop making Direct Payments.

Any concerns raised as a result would need to be discussed with the Team Manager and the Direct Payments Team Manager to decide on a further course of action.

It may be identified through a Direct Payments audit that the Direct Payments are not being used in full. The assessing staff should ensure that they always check the outcome of audits when they review and make a decision about whether further action is required. A surplus could indicate that all needs are not being met or that the Direct Payments are excessive to meet needs. This would warrant a full reassessment and consultation with the Team Manager about the appropriateness of continuing the Direct Payments arrangements. The Direct Payments Team can offer support and advice in relation to the amount of money that should be in an account under normal circumstances.

• It may also be necessary for an assessor/review officer to request an audit if they feel that one is required as an outcome of a care review.

In addition, a recipient may make a request for the local authority to review the making and use of Direct Payments and the local authority must then consider whether to carry out a review (see also: Section 8, Hospital Stays).

Where the local authority decides to reduce the amount of Direct Payments, it must provide reasonable notice to the recipient, and must set out in the notice the reasons for its decision.

The local authority must reconsider its decision, where requested to do so by the recipient, but is not required to undertake more than one reconsideration of a decision. When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or the young person) and must then provide written reasons to the recipient (and to the child's parent or young person, where the recipient is a nominee) of its decision following the reconsideration. The local authority may reduce Direct Payments following reasonable notice despite the fact that a request for reconsideration has been made.

The local authority may require the recipient to repay part or all of the direct payments, where:

• The circumstances of the child or young person have changed in a manner which has an impact on the appropriateness of the agreed provision;
• All or part of the Direct Payments have not been used to secure the agreed provision;
• Theft, fraud or another offence may have occurred in connection with the Direct Payments;
• The child or young person has died.

It must give notice in writing to the recipient, setting out the reasons for the decision, the amount to be repaid and a reasonable timescale within which the amount must be repaid.

The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child's parent or young person, where the recipient is a nominee).

The local authority may only seek repayment of any portion of the Direct Payments that has not already been spent on the agreed provision.

The local authority must stop making Direct Payments if:

• The recipient has notified the local authority in writing that they no longer consent to receive the Direct Payments;
• The recipient ceases to be a person to whom a Direct Payments may be made;
• Following a review, it appears to the local authority that:
  • The recipient is not using the payment to secure the agreed provision;
  • The agreed provision can no longer be secured by means of Direct Payments.
• At any point the local authority becomes aware that the making of Direct Payments is:
  • Having an adverse impact on other services which the local authority provides or arranges for children and young people with a care and support plan or a Education, Health and Care Plan which the authority maintains; or
  • No longer compatible with the authority's efficient use of its resources.
• It has taken reasonable steps to ascertain whether the young person consents to Direct Payments and the young person has not notified the local authority of their consent.

Where the local authority decides to stop making Direct Payments, the local authority must first give notice in writing to the recipient setting out the reasons for its decision.

The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child's parent or young person, where the recipient is a nominee).

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

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