OPERATIONAL & FINANCIAL POLICY FOR INDIVIDUAL BUDGETS

This policy has been created as part of the first pilot roll-out. There will be continual evaluation of the roll out of Self Directed Support may result in changes to the Resource Allocation System and any associated policies.

Table of Contents

1.REFERRAL PROCESS

2.SELF ASSESSMENT QUESTIONNAIRE

3.RESOURCE ALLOCATION –INDIVIDUAL BUDGET

4 TRANSITIONAL PAYMENTS

5.RESPITE- TRANSITIONAL PAYMENTS FOR EXISTING SERVICE USERS

5.DISCRETIONARY PAYMENT

6.CONTRIBUTIONS TOWARDS INDIVIDUAL BUDGET

7.APPEAL PROCESS

8.SUPPORT PLANNING

9.COMMISSIONING SERVICES

10.PAYMENT OF AN INDIVIDUAL BUDGET

13.CARERS ASSESSMENTS

14.Personal Assistant does not show

15. CHANGE TO HEALTH FUNDING

16.BUDGET MONITORING

17.PERFORMANCE INDICATORS

1.REFERRAL PROCESS

In all cases service users will be required to meet the eligibility criteria of substantial or critical before an Individual budget (IB) is discussed (except for Carers-see p. 21) Service users who do not meet the FACS criteria are to be signposted to the relevant services/agencies for support. Remember there are a number of Preventative services available to support care needs for both FACS and non FACs compliant service users.

1.1 Capacity to manage their own affairs

Where it is deemed that an IB would be the best mechanism to meet the service users need, an assessment should be made if the user has capacity.Ifa service user does not have capacity the social worker should consider working with the family members (if appropriate) to arrange an IB otherwise the LA should seek the most appropriate way to provide services to the service user.

In all cases the social worker should also assess the service user/representative suitability to manage their own financial affairs or with appropriate support, taking into account mental capacity and any historic or known issues of financial abuse.The LAwhen offering an IB has to continue to exercise its responsibility around Mental Capacity, Appointee, Guardianship and Court of Protection.

Note: Where the Council acts as the Appointee for the service user, the Appointee team should be involved in the decision when agreeing an Individual Budget.

1.2People who do not qualify for an Individual Budget

  • People detained under mental health legislation or on leave of absence from hospital;
  • Conditionally discharged detained patients subject to Home Office restrictions;
  • Patients subject to guardianship under mental health legislation and those covered by the new power of supervised discharge introduced by the Mental Health (Patients in the Community) Act 1995;
  • People receiving after-care or community care initiated under a compulsory court order;
  • People serving a probation or combination order requiring them to undergo treatment for a mental health condition or for drug or alcohol dependency;
  • Offenders released on licence who are required to undergo treatment for mental health conditions or for drug or alcohol dependency;
  • People who are subject to the equivalent Scottish mental health or criminal justice legislation.

2.SELF ASSESSMENT QUESTIONNAIRE

2.1Components of the Self Assessment Questionnaire

In every case a service user will be asked to complete a self assessment questionnaire, the questionnaire will be used as the basis for assessing an individual’s resource allocation.

The key components of the self-assessment questionnaire are:

  • Personal care
  • Nutritional needs
  • Practical aspects of daily life
  • Physical, mental health and well-being
  • Relationships and social inclusion
  • Choice and control
  • Risk
  • Work, leisure and learning
  • Travelling
  • Caring/parenting
  • Social support
  • Natural Support

In all casesthe service user should be fully explained the importance of the self assessment and the implicationif not correctly completed. The service user can access the self assessment form via the internet or have it posted to themselves or representative. They also have the option to receive support to complete the questionnaire:

a)As part of their FACS assessment;

b)From family members or friends;

c)By requesting a separate visit from a Social Worker/Care manager.

d)By approaching an independent or voluntary sector provider

e)Via the Local service centre

2.2Methodology of Self-Assessment Questionnaire

It is a consistent and simple method by which all service users can assess their own level of support. It comprises of two elements: a Self Assessment Questionnaire and Price (£) Per Point.

New Service User

New service users will need to complete the Self Assessment Questionnaire after their FACS criteria has been agreed.

Existing Service users

Existing service users can be offered an IB at their review; however this has to be considered in line with the Council’s overall targets, financial commitment and ability to offer the service to both new and existing service users.

2.3Completing the Self Assessment Questionnaire

A self- assessment questionnaire should be returned within 28 days of being sent to the service user/representative. If the form is not received within the time, contact should be made with the individual/representative to determine the reason for the late return of the form.

On receipt of a self assessment questionnaire, checks should be made that:

a)All the questions have been correctly completed;

b)The form has been signed by the service user and/or their representative;

c)Details of the person responsible for the administration of the individual’s financial affairs has been provided this includes relationship to service user, contact telephone number and address.

As the questionnaire is used as the basis for determining the individuals’ resource allocation the onus will be on the individual, family or their representative to provide a comprehensive picture of need. The social worker will be making the best decision on the information provided.

However where there is doubt about the answer to the questions within the questionnaire i.e. possible risks to the service user, seek clarification from the individual or their representative/family member. If any of the information as noted above is missing, the form should be returned to the service user/representative for full completion.

3.RESOURCE ALLOCATION –INDIVIDUAL BUDGET

On receipt of the form, the social worker/care manager will calculate the level of points to be awarded as part of the Resource Allocation. The point allocation is dependent on the information provided within the questionnaire.

3.1Authorisation of Resource Allocation

All resource allocation (IB) should be authorised. The level at which the Resource Allocation has to be authorised will be dependent upon the service group. The authorisation levels for each group are detailed below:

Weekly Authorisation Level / Overall Package Level
OLDER PEOPLE
Senior Practioner
Team Leader
Service Manager
Head of Service
LEARNING DISBAILITY
Senior Practioner
Team Leader
Service Manager
Head of Service
PHYSICAL DISABILITY
Senior Practioner
Team Leader
Service Manager
Head of Service
MENTAL HEALTH
Senior Practioner
Team Leader
Service Manager
Head of Service

Note: Services need to ensure that the authorisation levels are consistent with the Council’s Scheme of Delegation as documented within the Council’s Financial Regulations and within the agreed yearly budget.

3.2Notification of Indicative Individual Budget

All service users should be notified of their allocation within two working days of the questionnaire having been received in the service, the exceptions will be:

a)Where there are considerable/complex needs and the case has to be presented at panel. This will be necessary in cases where the need indicates that the service user may be entitled to a health contribution towards their Individual Budget;

b)The case is to be referred to the Risk Panel to assess the risk associated with service user if an Individual Budget were to be agreed;

c)There are discrepancies on the allocation; allocation is inconsistent with need.

In these cases the service user should be notified of their Individual budget within 7 working days.

3.3HEALTH CONTRIBUTIONS

Where the costs of the care package are shared between health and local

authority, the notification to the service should separatethe amount payable by

both parties. Both the health andlocal authority contribution can be paid via an

Individual Budget. The health contribution costs will be recharged to the PCT on a

quarterly basis.

3.3Inconsistency between Self Assessment Questionnaire & Resource Allocation

New Service User

In some circumstances the level of resource allocation to the individual may be inconsistent with the assessed need. This can be due to:

a)The service user assessing their ability to do more than what they can realistically achieve based on their known medical condition and supporting medical evidence;this resulting in a resource allocation less than required with someone with similar need.

b)The resource allocation may be far greater than that expected of someone with exact or similar need or/and the professional medical advice provided. Resulting in resource allocation being greater than would be awarded.

c)All levels of additional resources i.e. natural support have not been correctly identified by the service user or their representative

Where the resource allocation is less than expected it may be:

  • Appropriate the budget holder considers a ‘transitional’ payment (p.7) for a period of three months pending a review. At the review it would be for the manager to consider if the Resource Allocation can be reduced to the original assessment without any risk to the service user or remains at the revised level;or

Where the resource allocation is greater than expected:

  • Arrange a meeting with the service user to seek clarification of the information provided. This should be done within two working days of the questionnaire being received. A letter should be sent to the service user and/or their representative (if applicable) outlining the reasons for the visit and the points of clarification to be discussed.

If a service user/representative refuses the visit the service user and/or their representative should be advised that the Council will seek the most appropriate way to deliver services required to meet the individuals need.

Existing Service users

The Resource Allocation may identify that the service user’s budget will be less than the current costs of service. There may be a number of reasons for this:

a)The service user is in a current placement greater than would be paid under an Individual Budget;

b)The service user’s care provision is being delivered via traditional care provision and is commissioned at a higher rate than would be purchased via an Individual budget;

c)Service user’s needs have changed.

In these circumstances a ‘Transitional’ payment may apply (see below)

3.4Minimum and Maximum Resource Allocation

There will a minimum and maximum amount payable via an Individual Budget; this will depend on the service group. The table below outlines the minimum and maximum levels payable to a service user:

Service Area / Minimum Level (£’s p/w) / Maximum Level
(£’s p/w)
Older People / 100.96 / 432.69
Learning Disability / 46.15 / 1,038.46
Physical Disability / 28.85 / 432.69
Mental Health

4TRANSITIONAL PAYMENTS

A transitional payment will apply where it is assessed that a service users current cost of package can not be reduced to the level assessed under the Resource Allocation without it having a significant impact on meeting the service user’s needs. The following consideration should be made before a request is made for a manager to consider a transitional payment:

4.1COMMISSIONING COSTS

In some cases service users may be resident in an appropriate placement however the overall costs are above the Indicative Budget Allocation that would be awarded. You may need to request:

a)For Commissioning to renegotiate the costs to ensure that the existing contract better meets the individual support which may include employment, education, training and social isolation at a more competitive rate.

b)A transitional payment to cover the additional costs while the care package costs are being renegotiated.

Note: It may not be possible in all cases to negotiate the costs of the package and in order to sustain the individuals’ environment, support and meet their need a transitional payment may need to form part of the base Individual Budget.

4.2Change in need

A service user may have been in receipt of their existing care package for considerable length of time but with a reconfiguration of their care package, the Individual Budget allocation could meet their need. In these cases:

a)The service user is to be notified that through their Support Plan, there is an expectation that there will be a change in their care provision to meet their care needs;

b)A transitional payment of up to three months will be awarded to enable the service user to redesign their support plan, obtain the necessary support and provide a reasonable amount of time to test if the new configured service meets their need, this will be referred to as ‘Transitional Planning’;

c)After three months of transitional planning the revised Resource Allocation-Individual Budgetto be applied.

Note: Three months is given as a target date however each service user’s circumstances will need to be looked at independently.

Similarly, there could be an increase in need; this should go through the usual process of being presented to Panel for a decision depending upon the level of increase to the existing care package. However the increase in package should be consistent with the revised Resource Allocation of that person with that level of need. If this revised Resource Allocation is still below that of the existing care package then a ‘Transitional payment applies and appropriate action should be taken to review the Commissioning costs.

In all cases:

i)The transitional payment should be agreed by a Senior Manager, authorisation will be dependent upon the level of the Individual budget to be allocated;

ii)No transitional Payment is to be allocated for more than 52 weeks, however there may be exceptional circumstances where this cannot apply. Transitional payments of up to 52 weeks should only apply to ‘existing cases’.

A transitional payment will be applied from 2009 to 2011. It is expected that by 2011 that all transitional payment can be phrased out with the Resource Allocation better reflecting the range of services required and available to service users at a competitive market price.

5.RESPITE- TRANSITIONAL PAYMENTS FOR EXISTING SERVICE USERS

Newham will be offering up to a maximum of 4 weeks planned respite per annum. This excludes emergency respite which will be considered based on the individual circumstances.

Where the individual’s current respite is over 4 weeks, they should be advised that the Self Assessment Questionnaire will be used to determine the Individual Budget allocation.

Current Respite is less than or equal to four weeks Respite

If the current respite to the individual is less than or equivalent to 4 weeks, however the IB allocation is less than there current allocation, a transitional payment will be payable.

Example:

Mrs Better receives 3 weeks carers respite per annum at a current cost of £5,000 per annum as part of an ongoing care package of £25,000 per annum. Mr Batter’s IB allocation is £23,500 per annum.

In this circumstance a transitional payment of £1,500 will be made.

Current Respite is more than four weeks Respite

If the current respite to the individual is more than 4 weeks, however the IB allocation is less than there current allocation, a transitional payment will be payable up to maximum of four weeks respite.

Example:

Mrs Better receives 5 weeks carers respite per annum at a current cost of £7,000 per annum (£1,400 per week) and the overall care package budget is £37,500 per annum. Mr Better’s IB allocation is £33,500 per annum.

The maximum of 4 weeks respite would costs £5,600 per annum. Mr Better’s overall budget should be increased to meet the at least four weeks respite

Calculation of Transitional Payment

Current Budget £37,500

Less Respite 5 weeks respite£-7,000

Basic Budget£30,500

Individual Budget£33,500

Basic Budget£30,500

4 Weeks Respite£4,800

Revised Budget£35,300

Transitional Payment£1,800

5.DISCRETIONARY PAYMENT

A discretionary payment would be a one-off payment made to a service user/their representative which will benefit the service user to start meeting their need but may not be required for an extended period of time. A discretionary payment should be for a service/activity required for more than one week but less than three months.

Example

Mrs X aged 77 is discharged from hospital and has gone through the enablement service to regain her skills to live independently. Mrs X has had a maximum of six weeks enablement service; however feels that she is ready to for her service to be reduced. The self questionnaire supports this but the Care support worker who has supported Mrs X within the enablement service feels that she would benefit with a couple more hours of additional care for two weeks but not beyond that.

Mrs X agrees to this, her RAS is agreed with a discretionary payment for a maximum of two weeks to the costs of £25.00 per week.

Other examples may include a purchase of a washing a machine or driving lessons to service user who may be entitled to Motorability allowance.

Note: All discretionary payments should be signed off by the Group Manager

6.CONTRIBUTIONS TOWARDS INDIVIDUAL BUDGET

The level of contribution towards the Individual budget will be dependent on the level of natural support and financial circumstances. As part of Individual budgets there is an expectation that all forms of resources are taken into account. This includes:

a)Natural forms of support- family members, groups etc.

b)Financial resources that can be used to help purchase services.

6.1Natural Support

Natural support should be taken into account where there is evidence that the family member is providing the support for the individual. In considering the support:

a)A carer’s assessment (see p. 21) should take place, the carer should complete their own Self assessment form followed by an independent support plan.

b)Self- Directed Support does not exclude a family member as being the support for an individual. In these circumstances where the service user wishes to use a family member for all support rather than brokering a service a distinction will need to be made between:

  1. That service which otherwise has and would continue to be provided by the family i.e. night service
  2. That which is the service required for the individual to allow them to live independently and is reasonable to be provided by the family member.
  3. Advisethe service user/their representative that the carermay be required to pay tax and national insurance (if applicable) and/or it mayaffect the carer’swelfare benefit entitlement (if applicable).

6.2Financial Contribution