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Section 7 MAKING, MANAGING AND MONITORING PAYMENTS
171. Section 6 looked at users' information, support and training needs. Section 7 considers the process of making, managing and monitoring payments.
Making payments
172. It is good practice to make payments in advance to ensure that recipients are in a position to pay for the support they are purchasing. It is, however, up to local authorities to decide how frequently payments should be made. It is important that where direct payments are financed from more than one local authority budget the individual receives one single payment to cover all the services he or she has been assessed as needing.
173. Local authorities will need to set up mechanisms that enable them to monitor payments which are made and which minimise the risk of money being misspent. In considering what procedures to put in place, local authorities should bear in mind the likely effect of different options on the circumstances of people who are likely to receive direct payments. Whatever the arrangements for payment, they will need to be reliable, as late or incorrect payments may put at risk the persons' ability to secure the support they need. The local authority may also need to set up procedures for making additional payments in emergencies, for example if needs change. Local authorities should tell people, before direct payments begin, how and when the payments will be made. Where payments are made directly to a bank account a written statement of the payment details should be sent to the individual for information.
Managing payments
174. People may receive as much assistance as they require to manage the money but they remain accountable for the way it is spent. People may ask carers, family members, User Controlled Trusts, Circles of Support, peer support or other third parties such as direct payments support organisations to help them manage direct payments. Such support can be invaluable, whatever its source, and users may also choose to buy in assistance, for example using a payroll service from a local support organisation. There is no restriction on who may help a person in this way, although the restrictions on paying relatives described in section 5 will apply.
175. If the authority concludes that someone could only manage direct payments with help, it should satisfy itself that appropriate help is available over a sustained period before deciding to offer direct payments. Where significant help is being provided, the local authority will need to ensure that any monitoring and review procedures involve direct contact with the individual for whom the payments are made, if necessary in the absence of the person who is helping him or her. This is to ensure that the individual is content with the way in which the direct payments are being used. Both local authorities and people receiving direct payments should also be aware of the potential conflict of interest if the individual secures services from the same person who is helping him or her to manage the direct payments. The same applies where an attorney or guardian intends to provide services for the individual. For that reason the Executive advises that the person helping to manage the direct payments or giving consent to direct payments on behalf of the service user should not be the provider of the service being paid for by the direct payments.
176. Some people who initially need help to manage their direct payments will in time be able to manage on their own. However, it is possible that not everyone will be able to do so. There is no restriction on the length of time that a person may receive help to manage direct payments.
Paying direct payments to a third party
177. With the individual's consent, the payments may be made to a third party but the person who gives consent to the payments must retain control over how they are spent. Direct payments are intended to facilitate independent living, not to switch from dependence on the local authority to dependence on a third party. This means that people may express a preference about how a service is to be provided, and delegate the details to a third party so that they will not have to authorise every transaction. However, it must be open to the individual to overrule any decisions made by the third party. Local authorities should satisfy themselves that the relationship between the individual and the third party has been discussed and agreed before direct payments begin. They must also be satisfied that the individual is aware that he or she can receive the payments direct.
Management during periods of fluctuating health conditions
178. Some people with fluctuating conditions, such as mental health service users, may only require help to manage direct payments at certain times. It is important that local authorities satisfy themselves that individuals have support in place when they need it. In these circumstances there is a need to plan ahead and make arrangements whereby a designated person or group of people ( i.e. circle of support, trustees) can be given permission by the user to take over during a period when he or she is unable to manage. Having some form of advance planning or advance directive should be considered an essential component of direct payments for people whose condition may fluctuate or deteriorate over time. This would ensure that when they become ill they retain as much control and choice as possible of the arrangements and are able to regain full control if they become well again. This type of advance directive along with 'Living Wills' or User Controlled Trusts may help prevent a recipient reverting to local authority provision. Advance directives allow people with mental health support needs to state in writing what needs they have if they become particularly distressed or unable to manage. For example a person could write down what a support worker should do if they have a crisis, or write guidelines for how to assess risk, or provide a list of useful telephone numbers that the support worker could phone for advice or information if necessary 25.
179. If the person's condition is likely to deteriorate to the point where he or she is unable to manage even with assistance, the local authority might consider ways of enabling the person to plan, in advance how this is managed, for example, a power of attorney (see section 3 on the Adults with Incapacity Act). A back-up system controlled by the local authority must be set up and triggered during periods when the person is unable to manage. Equally, local authorities might decide to offer direct payments to people whose condition means that they are likely, at some point in the future, to lose the ability to manage permanently. In those circumstances they will still need to satisfy themselves that safeguards are in place to alert them in such circumstances. People whose condition is likely to fluctuate or deteriorate permanently should be given an opportunity to explore any worries they may have about their ongoing ability to manage direct payments. In such cases the local authority should make it clear to the individual that he or she can decide to stop receiving direct payments at any time and receive local authority services instead.
Emergency assistance
180. Making direct payments, rather than arranging actual services, does not affect a local authority's function of providing emergency assistance under Section 12 of the 1968 Act or Section 22 of the Children (Scotland) Act 1995 ('the 1995 Act'). If the authority considers the circumstances to be so exceptional as to require such assistance, they may provide it in respect of the services to which the direct payments relate (see Section 12C (3) of the 1968 Act).
181. Local authorities must discuss with each person what arrangements he or she will make for emergencies. Local authorities must ensure that the person receives the support he or she needs if the usual arrangements break down, for example through sickness of one of the person's personal assistants. It is reasonable for a local authority to expect the person to have contingency plans and these should be clarified at the outset. However if a local authority becomes aware that someone is unable to secure support to meet his or her needs, then its responsibility to arrange services for that person is the same as if it had not made any direct payments. The local authority will need to be prepared to respond in these circumstances just as it would with any other service user. It may decide to step in, albeit temporarily, and arrange the necessary services, but it should first consider providing assistance to enable the person to continue to manage his or her own support.
182. Examples of contingency plans which people who receive direct payments might make include making arrangements with independent agencies for emergency cover, or recruiting personal assistants who are prepared to work additional shifts at short notice when necessary. However, it remains possible that difficulties will arise which have not been anticipated and which cannot be covered by the arrangements the individual has made. In these circumstances, it will be helpful if the direct payments recipient knows they can contact a named individual in the local authority or a local support service whom they can ask for help.
Local monitoring of direct payments
183. There are two forms of monitoring that local authorities undertake for direct payments: monitoring of service and monitoring of finances.
184. Consenting to receive direct payments means the local authority no longer arranges services for that person, so long as it is satisfied that the needs will be met through the arrangements made with the payments. It follows that the local authority will need to set up monitoring arrangements so as to satisfy itself that arrangements are meeting needs.
185. Monitoring arrangements should be consistent both with the requirement of the local authority to be satisfied that the person's needs are being met and with the aim of the policy to increase choice and independence. Local authorities should seek to focus on whether the person's needs are being met, rather than on the service being delivered in a certain way. The local authority should discuss with the individual what steps it intends to take to fulfil its responsibilities in this area.
186. Local authorities should discuss with recipients the information they will be expected to provide and the way in which monitoring will be carried out. Direct payments should not begin until the recipient has agreed to any conditions, which are necessary for monitoring purposes.
187. Each local authority will need to ask itself how it would know if someone was experiencing difficulty managing direct payments. It may be appropriate to rely on someone who has been managing his or her own services for some time to ask for extra help if he or she needs it. However, local authorities should not rely on people asking for help, particularly when someone begins to receive direct payments for the first time. Regular reviews should be arranged to ensure that the local authority has an opportunity to discuss the direct payment's arrangement with the individual. Where a local authority wishes to ask the person whether he or she is satisfied with the services he or she is securing, it should ensure that it communicates directly with the person wherever possible. Local authorities should seek to ensure that people do not feel inhibited from expressing reservations about the services they are purchasing, or about any other problems they are having in managing their direct payments, by a concern that their direct payments will be stopped automatically. A local independent support organisation or independent advocacy service may help some people raise any issues which are giving concern.
188. Direct payments packages which include health services will require to be monitored by personnel with the necessary expertise to judge whether these particular assessed needs are being met. In most instances this will mean that health care staff will need to be involved in the monitoring process.
189. Each local authority should also set up financial monitoring arrangements for audit purposes, to fulfil its responsibility to ensure that public funds are spent on the intended services. CIPFA have produced guidance for local authorities on this point and local authorities should ensure that up to date advice is being used 26
190. For direct payments to work, it is essential that these two forms of monitoring are co-ordinated. The financial monitoring should be carried out by a finance officer and monitoring of the services by the care manager/social worker. It is essential that that monitoring information is exchanged internally and that all those involved understand the purpose of direct payments, and the role that the local authority's monitoring plays in the successful operation of the policy. In particular, information from both forms of monitoring should be considered in any decision to change the level of, or stop, direct payments.
191. As well as monitoring how well direct payments are meeting the needs of individuals, local authorities will wish to monitor how local direct payments schemes are working overall. In doing so, authorities should actively seek the comments and suggestions of people who receive direct payments or who have considered receiving them.
Reviews and reassessments
192. Direct payments do not affect the local authority's responsibility to review the services the person receives at regular intervals. It is essential that local authorities carry out regular reviews of the direct payment arrangements. The first review date should be set when direct payments begin. People should be made aware that they can request a review sooner if their circumstances change. The purpose of the review is to establish whether the objectives set in the original care/personal plan are being met. However, at review time the local authority will also wish to be satisfied that the individual is protected from exploitation and abuse.
193. The local authority will wish to speak to the individual on his or her own during the review, if the individual needs support the local authority should ensure that the person is given the option of having support from someone other than the person helping to manage the direct payments or the person providing the services. Local authorities may also wish to speak to family members and carers. To satisfy themselves that the person is not experiencing any difficulties with the services being bought with the direct payments. A local user-led support organisation or independent advocacy service may help some people raise issues, which are giving concern. Where an attorney, guardian or parent is consenting to the direct payments the local authority will also wish to discuss arrangements with them.
194. It may be helpful to consider first whether the person's needs have changed, before moving on to review how he or she is managing direct payments and how well direct payments are working.
195. Local authorities should follow existing guidance on carrying out reviews. While an individual's needs should be reassessed at least every 12 months, initially at least the review of how the direct payments are working may require to take place more frequently. Following the review, the amount of direct payments may need to be increased or reduced.
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