Using Direct Payments in Norfolk’s Integrated Mental Health Services
Implementation Guidance to all Care Managers / CPA Care Co-ordinators / Locality & Team Managers
This guidance is for clarification purposes and should be read in conjunction with SSD Direct Payments Procedure: Operational Instruction 547. This guidance applies only to Norfolk’s integrated mental health services
What are Direct Payments?
· Direct Payments are cash payments made to an individual (via local authority social services departments) as an alternative way of meeting a social care need, either wholly or in part.
Key Principles
· Direct Payments should be used to enable people to exercise choice and control over their lives, to widen social, educational and employment possibilities and, as a key consideration, to reduce dependency on mental health services.
· In Norfolk’s integrated mental health services the only times when any social care service should be delivered other than by a direct payment are:
§ When the individual themselves has made a personal, positive and informed choice to receive care through a directly provided service and not via a direct payment.
§ When a full CPA risk assessment indicates that the person or others will be put at a substantive risk if care is not directly provided. (This must be kept under review)
What is a Social Care Service?
· Within the integrated mental health services this means any need that can be reasonably met by a service that is not of a specialist clinical nature. Examples are access to day services, support worker services, respite breaks, non-specialist alternative and physical therapies, education, leisure and employment opportunities.
· This guidance does not offer a definitive list as every person is different and care co-ordinators are encouraged to find creative and different solutions to individual needs.
· Direct Payments cannot be used to pay for clinical healthcare, most housing costs, clothing or general living costs.
· The Direct Payments Board is able to consider, through the Exceptions Process, any request for a direct payment that falls outside the stated criteria. (Contact numbers below)
Who is eligible to receive a Direct Payment?
· The majority of people over the age of 16 who are assessed as needing social care services have a right to direct payments. There are only very limited circumstances when direct payments would not be offered. (appendix 1)
· People must also be willing and able to receive Direct Payments and able to manage them (alone or with assistance) so as to meet their assessed needs. (appendix 2)
Who can set up a Direct Payment?
· Within the integrated mental health services a direct payment can be set up by staff of any discipline (e.g. OT, SW, CPN) who hold care co-ordination roles or who are responsible for undertaking needs assessments and agreeing a care plan. The agreed DP package must then be authorised by the individual Locality Managers through the normal financial process.
What does the Norfolk scheme offer?
· Payment to employ a support worker of the person’s choice, in lieu of an agreed domicilliary care package.
· A direct payment to undertake a respite (short) break which can be used to pay for a break anywhere within the UK (e.g. hotel, B&B, self catering or staying with relatives).
· Up to 5 hours of support for activities per day at the current direct payment rate of £7 per hour or payment of an equivalent amount towards the cost of an activity. People can use the direct payment to pay for both the cost of support and the cost of the activity provided the total cost does not exceed a maximum of £35 per day.
· A flat rate of £6 per week towards the costs of personal assistants' (support worker) expenses if required.
· Transport to be paid, if assessed as necessary, at actual cost.
These costs are for guidance - they do not represent a standard payment – each package should be costed and the Direct Payment must be enough to secure the service.
Where circumstances merit it these figures can be exceeded (if agreed through the Exceptions Process) but all agreed packages must be cost-effective.
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Process
The success of a Direct Payments package is dependent on the quality of the assessment:
· The needs’ assessments should be ‘person centred’ and must focus on outcomes.
· If the needs’ assessment indicates that the person requires social care support (as defined above), is not excluded by risk, and whose needs meet the SSD eligibility criteria, then a Direct Payment must be offered. (If this threshold is not reached and the person is not therefore eligible to receive a specialist social care service they will not be eligible to receive a Direct Payment and other options should then be considered)
· Once the needs, outcomes and level of support required have been agreed with the service user a range of community activities or facilities should be considered which could meet these requirements. N.B. assessors should avoid thinking in terms of ‘services’.
· Normal charging procedures will apply to ‘domicilliary care’ and ‘respite’ packages, and the service user must be made aware of any charges. No charges will be made for ‘support worker services’ or ‘day activities’.
· When these have been agreed a fully-costed Direct Payments package should be put together and submitted for authorisation to the Locality Manager (following normal financial procedure).
· Only in cases where there is no viable alternative, or where a service user has made a personal, positive and informed choice, or where the person would otherwise be put at increased risk, should a mental health service be directly provided
· When the package has been approved all contracts and bank details should be sent, with the signed DP Terms & Conditions, to the Direct Payments Office (138a Hall Road, Norwich NR1 2PU).
· Where the person is going to enter into an employment contract, details should be sent to Independent Living Norfolk (Tel. 01603 785200). They must see all potential employers and will also be able to arrange, or advise on, any necessary support arrangements with the service user (e.g. advice on recruitment and employment, CRB checks, PAYE etc.)
· Where a service user is not in agreement with any decision around direct payments, or wants independent support to consider direct payments, they are entitled to contact the Direct Payments Advocate at DP Advocacy Norfolk (tel. 01953 851686)
Supporting People Payments
· For guidance regarding the use of Supporting People monies and Direct Payments please see appendix 2.
Responsibility
· To facilitate service user choice of a direct service or a direct payment it is the responsibility of the joint managers of the integrated mental health services to ensure that there is a sufficient balance of block & spot-purchase funding available.
· It is each individual workers responsibility to ensure that Direct Payments are offered and made.
· It is the responsibility of Locality managers to ensure that all team members are fully trained, not only in DP procedures, but also in the skills required to properly, meaningfully and supportively explore DP alternatives with service users.
· People using direct payments remain the clients of the integrated mental health services and are entitled to have their needs met via direct services when their own arrangements break down and they are unable to make alternative arrangements.
Monitoring
· Locality Managers will be responsible for maintaining appropriate management of the use of Direct Payments.
· Locality Managers will provide regular monitoring information to the Commissioners on the uptake and use of Direct Payments.
Help and Advice
The Direct Payments Team welcomes all queries – PLEASE PHONE – even if you feel that you should know the answer.
Gill Stewart, Direct Payments Officer: Tel. 01366 387365
Direct Payments Office Staff: Tel. 01603 766278
Or phone:
Philip Williams, MH Direct Payments lead: 01603 307244 / 307292
Or refer to: DoH Direct Payments FAQ pages:
http://www.dh.gov.uk/assetRoot/04/08/04/06/04080406.pdf
Direct payments procedure and forms can be reached through the SSD Intranet –
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