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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views


Question 44: Will the easing of the restriction to pay family members living in the same household for administration/management of the direct payment increase uptake of direct payments? Will this create implementation issues for local authorities?

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19 comments

  1. Anonymous says:

    We feel this could open the door to potential conflicts/safeguarding problems. We do not feel this is necessary as, if family members do not feel they have the capacity to carry out this function, there are organisations that can be paid to do this – family members are likely to charged the same sort of money for this function, therefore, to use an external agency would remove any safeguarding concerns.

  2. Anonymous says:

    However for a few clients it is not helpful that their family manages their budgets. This is for two reasons: there is the temptation to spend the clients money in a different way that it should be spent. Secondly the more dependent the client remains the more money the family receive.

    An example of a family managed resource is the ‘mobility car’ where the person is unable to drive. This car may be used by every member of the family and very rarely by the client. For some disabled people they feel happy with this as it is their ‘gift’ to the family in thanks for the support they have received.

    Extending the provision to families will give the LA extra work.

    There should be a section of safeguarding which will pick up these issues and deal with them appropriately.

  3. Anonymous says:

    In principle it should increase uptake. However, people will need to clearly understand how this might affect benefits and any other consequences of a decision to be paid to manage direct payments. Potential consequences must be raised at the start of any process to consider this as an option . Clarification from the DWP on these issues would be welcomed.

  4. Anonymous says:

    The issue here is not about when things go well but when the arrangement breaks down. If the funds have been spent by someone else on household or other expenses, who will pay for the care?
    We believe that this area needs to be carefully considered as family support is crucial to the well being of vulnerable individuals; any breakdown in that relationship caused by mismanagement of any kind will create a major breakdown in delivery.

  5. Anonymous says:

    We do not anticipate a significant increase in take up as a consequence of this change. Direct payments tend to be used for one off or simple recurring spends (e.g. gym membership) or to employ personal assistants. The latter usage tends only to be when the need for the flexibility available in DP arrangements outweighs the inherent responsibilities of being an employer.
    Most people simply don’t want the hassle unless it is the only way of getting what they want.
    There may be concerns also with regard to impact on carer/ family benefits if this is in effect paid employment.
    A better incentive would be to simplify the DP management processes or have easier access to 3rd party DP managers.

  6. Anonymous says:

    We are not convinced that it is the lack of payment that is the main deterrent to family members taking on payroll responsibility, however we also acknowledge that where family members are providing this service that there should be scope for acknowledging this.
    We do have concerns about some of the safeguarding/ other risk issues that this might raise and feel that theses should be addressed.

  7. Anonymous says:

    having read the DP section more fully on this it seems that although an offer of financially rewarding a family member for what can be hours of admin to ensure the smooth working of support this person could also be the direct payment recipient (due to the diminished capacity of the disabled person)such is the case for myself so when this happens apparently this can then pose a problem and has to be decided upon by the council which in turn will mean that they say they cannot pay for your time because anytime there is any slight out clause of not paying for something that is the route that is taken. this should not be the case in truth as if you are the person trusted to organise the care and manage the finances properly of every year interview staff maybe train them, pay their wages, organise daily timetables of activities etc then surely if at an annual audit the hours this takes is recognised and an agreed sum of money is made available then that is all that is used so no different to any other payment/outlay that has to be organised on behalf of the disabled person. So I think that any out clause or reason not to do it should be removed otherwise we will be back to square one whereby some counties do it one way and others another when they should all be following the same set procedures. Either include it as a definite payment as an acknowledgement of the time/effort required to run the scheme or do not bother at all and leave it as it was. My case in point is to do with the exceptional circumstances that was included in the 2009 regs and apparently remains the same in the Care Act 2014 because the way it is written is of no help at all to the disabled people and their family members who live together because the local authority just quote at you sorry you cannot be paid for ensuring that your son continued to access his activities in the community today when your one and only trained carer was off sick because you are related and live together. They do not even attempt to look at the other items listed that should in fact make them say yes today there was no one else to support your son so today you do have an exceptional circumstance and you can be paid. The council are supposed to consider short term care needs and/or emergency support needs, and/or medication issues, and or communication difficulties, in the past we have had all of these with our son being severely autistic and epileptic and having just 1 PA who we had to train to meet our sons needs yet when we have to go running to assist or the PA is sick so we cover the whole day of planned activities thus loosing our own anticipated respite time we do it with no monetary recompense and no acknowledgement of being in exceptional circumstances. It is unfair and unjust that the way that exceptional circumstances is stated can then be just ignored/denied by a council when they are asked to recognise it – I would like to suggest that someone looks at changing this so that family members reliability and availability do not get systematically abused by the local councils as free support. We do not want or need to be the backup when things go wrong but when nothing else is in place and nil funding to put anything in place and the council says you have chosen to receive DP so you have the responsibility for everything now is perhaps why there are DP take up problems. Please remember we are in the caring role for all the rest of the time anyway so the time that our son is out in the community enjoying activities with his PA we do try and get some respite time to recharge our batteries.
    It has obviously been recognised that at times family who live together could well be the only people available to support the disabled person because of communication problems, in depth knowledge of their needs and the temporary breakdown in the current arranged provision and this has been stated in the 2009 Regs to be accepted and recognised. HOWEVER Councils refuse to acknowledge it and I would like to suggest that an inquiry to ask each council how many exceptional circumstances have been agreed/approved by them I think you will find that some counties probably have zero – proof that the current way that it is written leaves too much scope for the council to refuse the EXCEPTIONAL CIRCUMSTANCES request. We do not want the job which is why we have trained 1 PA and have been asking for funding for a 2nd PA whom we will also have to train but at least then we should have a high percentage of guaranteed respite time we will no longer have to be the contingency. It must be beneficial to the disabled person themselves for a family member to step in so that they can still take part in their community activities with the least disruption and the family member should be recognised as working those hours and recompensed as any body else would be. Please remember that many disabled people are able enough to be able to use AGENCY STAFF and therefore not ever come across this problem but when you start dealing with severe autism and incontrolled epilepsy, complex needs, communications problems, routines etc an AGENCY member for the day is not an option.

    CAN EXCEPTIONAL CIRCUMSTANCES possibly be something that is included in a SUPPORT/CARE PLAN in that if someone is recognised as having such complex needs and specific care then the CARE MANAGER can include in the care plan that when the support is unavailable due to holidays/sickness etc or additional support required due to health, medication side effects, seizures etc that EXCEPTIONAL CIRCUMSTANCES WILL THEN PREVAIL FOR THIS PERSON.

    Councils tell DP recipients that we are responsible for everything we have chosen to receive DP and we have to arrange everything basically we give you the money and you get on with it. DP should be a positive way forward for disabled people but there is a lot of work still required on the part of the council.

  8. Anonymous says:

    We did not know that this restriction applied and it never crossed our minds that we could even ask to be financially rewarded for organising/working the DP for our son who has diminished capacity.

    there can be a lot of admin work (hours) required especially when someone has very complex needs and maybe several support workers etc so the fact that this job (and it is an extra job you have to do) could be recognised by councils and have some kind of monetary reward could maybe help to improve take up of the DP option however I think that it needs to be a specified amount according to the size of the budget managed or degree of complexity of the client otherwise counties and families themselves will be having lots of varying amounts. Someone needs to come up with specific sums of remuneration that would be fair for the work expected if this is a route that is to be followed

  9. Anonymous says:

    Not sure it will increase the uptake – because of the technicalities involved in managing a DP

    Safeguarding issues if a family member for example doesn’t pay NI and manage the DP well. How do you safely monitor it?

    Big issue – lots of agreement on this point

    We don’t have the capacity to do the necessary checks on whether the family member is suitable

    If it were my DP I would rather have SCC pay SILC and have the experts do it then have it paid from my budget for a family member to do it

    Lots of clients don’t have family members – so they need an SMA from SILC

    There may be some people who would prefer a family member
    This is the intention – to increase choice and control

    People find managing DPs very daunting and they need that professional support

    With mental health clients – even if there is capacity, you can still mismanage the money – so what happens with that

    They would support this in principle, but would have concerns around safeguarding and people being exposed to financial abuse – but it would be good to have the choice

    Summary
    No strong views either way – but the choice aspect is a positive thing

    Concerns over safeguarding – this was supported by everyone

    It’s a burden on carers – the DH are wanting the carers to do more – this is how we all interpret it

    Is this a good thing?
    Answer – For some people it’s a better option that a family member can manage the day to day of the DP on behalf of the person

    The implications on the service user – the carer is having another strain put on them. Carers have enough to do – we need to stop putting the onus onto the carer

    The danger of this is that it will make the carer feel they have to do more

    The carer is occupied full time anyway – and therefore they do not need any other administration on what they are already doing 24/7

    As a carer – what you decide to do on one day may be different – the workload has peaks and troughs – so on one day you might feel you could cope, yet another day it could feel too much and overwhelming

    Also – it’s a potential increase in cost to the LA – i.e. if it isn’t by a chunk of the Personal Budget – then the PB will have to be increased to cover the cost

    We would start off by saying this needs to be met within the existing personal budget – but the budget may be increased if necessary

    Who number crunches the paperwork has no end effect on the user
    A side issue – DPs often get a bad press – e.g. If you have support through a care agency – you get 9 hours – then if you go to DPs – you can’t get the same hours as it doubles the cost

    The Q is accepting that there are lots of burdens on DPs – it’s trying to make things easier for them

    Carers see this as a potential burden – Strong view

    Q – Will there be rigorous tests done on the person? Providing there is a robust system in identifying then it shouldn’t’ be a problem. As it ultimately increases choice – and it’s not just carers – it could be a family member who takes on this role

    DH – there is a safeguarding issue – and we would need to be mindful of who we allow to do this role

    Another point – that bringing in the family dynamics can bring in another dimension – and taking it away from the independence of the service user?

    It’s about how we introduce it – if it does come in – we need to make sure we are doing it properly – if we are talking to carers – we need to know we are not taking their first words – and let them have time to think about it

    SILC manage it very well – 2 people said this

    Q – Why can’t SDS payroll payments be done by county council accountants – a big policy question

    – A Q TO TAKE AWAY
    It’s a control issue – i.e. people having the ability to choose who does it is important

    We have a lot of self funders – if we give all the responsibility on the carer – is it the carer that has to source the care as well as manage the DP – this is a lot to take on
    – In response to this – Under the Care act – we have a responsibility onto provide more info and advice and SCC will have to ramp up what we do in terms of info and advice

    Q – What happens if a person lives on their own and doesn’t have a family member

    A – It’s a choice – and this doesn’t replace SILC support

    Q – If a family member that lives with you is being paid, how would that money be treated if they were on carers allowance? Would it be treated as income? Would it be disregarded when benefits were being calculated?

    Good point – agreed by all as a good point – no answer given

    Q – Would it still be regulated – who regulates the person?

    A – The LA would have to be satisfied that the family member is appropriate – and able to deal with the complexities of the reconciliation process

    If someone is working and is receiving payments for DPs is this taxable?

    Carers already under pressure – this could be seen as an added burden – a view felt strongly by the group

    Q – Would the person need a power of attorney?

    A – In theory there shouldn’t need to be a POA – BUT – if the person deteriorates – then this would be picked up.

    This opens people up to more financial abuse

    Family members wouldn’t meet criteria for CRB checking

    There may be some relatives which would welcome this, but ultimately it won’t create a Sea Change

    The changes may benefit a small group – who are already very much in charge of what happens

    But there won’t be a huge uptake

    It will put an added pressure on carer’s support organisations
    How often will it be reviewed? – i.e. that the carer is continuing to cope with this extra role – agreement from all

    There will be added pressures on the LA to check these people
    It will be seen a good thing in some people’s eyes

    Summary
    Added burden on carers and carers support organisations

    Added burden on LA to review the family members as appropriate

    Agreement that the choice would be good, and some families would welcome it

    The majority of the group don’t think it would increase DPs themselves

    Point which needs extra clarity –
    Tax implications – If someone is working and is receiving payments for DPs

    Will the easing of the restriction to pay family members living in the same household for administration / management of the direct payment increase uptake of direct payments? Will this create implementation issues for local authorities?

    is a very good idea – allows for greater convenience.

    not sure will increase uptake significantly – the admin/ management will make it a complex job. Not sure if will make a huge difference – a fair amount of agreement to this point from the group.

    Agreement that this is unlikely to make a difference – from a carer’s point of view, they want to get rid of the admin not increase it – difficult to do admin work after full day’s caring

    It was suggested that a person might not want someone outside of the family managing their DP? However it was pointed out that someone has already gone into the financial details to get the DP in the first place – is just sharing the details with someone else.

    Already lost privacy. This argument does not hold up.

    better for SCC to do it

    depends how the proposal is being presented – i.e. as a choice, that there are services out there to support and help. The risk to the proposal is that people/ carers may want to help, but may not realise how complex this could get and how it would change over time – i.e. they will inadvertently sign up for more than what they can handle.

    noted difficulties getting reconciliations back in – carers found complexity too much – half the group agreed – including the Surrey Coalition, Carers’ support.

    Was largely consensus that the group did not think the proposal will significantly increase the uptake – largely due to the complexity/ admin and management involved for carers. Agreed that strong support would need to be in place.

    noted that admin does not have to include the payroll –it is important to be clear what is meant by admin and management. Providing something that is already happening is good and there are positives to the proposal (i.e. extending support and control).

    But, support needs to be in place, otherwise the proposal has the potential to decrease the uptake – i.e. concerns about making mistakes/ getting it wrong could be a disincentive for uptake

    Would the payment be treated as income? Would this have an impact on entitlement to benefit etc? – need clarity from government as to the implications for the carer. We are not sure how much we are talking about yet –i.e. is it a set amount, a percentage of direct payment etc?

    Will this create implementation issues for LAs?

    will need to train carers, decide whether the carer is an appropriate person. How do we check the appropriateness? – Financial checking, not already in receivership – how much checking do we do? Will need to look at relationship issues- will it make situation uncomfortable, put pressure on carer, change power dynamics? – feels slightly uncomfortable

    Training and support is a huge issue – will this create a training and support need the LA are going to have to provide?
    Questions regarding how much trust does the LA have and what are we still responsible for?

    Will the proposals replicate what it is in place for payments for people without capacity? – People take on a huge amount of responsibility. Surrey are lucky to have a level of support from SILK. Receives are out of date for care as well as DP – to be able to address this (i.e. 6 monthly) would be a very skilled piece of work and we do not currently have the staff to do this

  10. Anonymous says:

    This may increase direct payment uptake as family members living in the main household may be more likely to support someone to manage or administer their direct payment if they are being paid to do so. This is unlikely to lead to a large increase in uptake as the payment available to pay for administration is unlikely to be high.

  11. Anonymous says:

    Do not think this will have major implications – not sure if it will encourage uptake but think that it will have to be managed. Allowances would have to be proportional to what input the family member has in terms of helping manage the account.

  12. Anonymous says:

    This is in principle long overdue recognition of the responsibilities of someone managing what is in effect a small business, but as others have indicated, imposes an admin burden on the funding authority to increase measures to prevent risks at a time of serious pressures on budgets.
    In a number of cases the family member will also be a PA to the user, yet at 12.56 the regulations are hostile to the method of delivery of funding being one that is rapidly becoming best practice in providing effective monitoring capability to the funder.
    Direct Payments have been identified by a number of CIPFA members as an increased fraud risk compared with DHSS systems. Where the main PA is in practice managing their own pay is a clear conflict of interest and therefore this will be targeted by a small number of agents.

  13. Anonymous says:

    Whilst this sounds great in theory, without adequate monitoring and safeguards the risk is that
    a) individuals will lose essential support as a consequence of paying family members – a payment they are unlikely to say no to because they already feel guilty about ‘how much trouble’ they cause their family;

    b) there is a risk of financial exploitation.

    If people have large. complex support packages that need a great deal of management, additional money should be made available for this, not taken out of the budget for the actual support the individual needs.

    Failing to do this will not make Direct Payments more attractive to the individual Disabled person – it will make them less attractive because they will be getting less care support.

  14. Anonymous says:

    I hope that DBS is a requirement when a person is hired as a PA, as this currently is open to abuse and abuse behaviour of people who are a risk to adults at risk. A DBS check, regulated and monitored by quality assurance teams

  15. Anonymous says:

    I think it will cause tension locally, with who the LA offer this to and not.

    In practice most family members would prefer not to do payroll, but may still be putting significant effort into sorting rotas and staff issues, and may well should be paid for this. My concern would be that LA’s would then not allow the family member to pay for professional payroll, which could lead to people taking on the role and getting into difficulties.

    The starting point should be the allocation, and whatever support needed to manage the package to be taken into account, as long as it is in budget.

  16. Anonymous says:

    I manage my husband’s direct payment and do all his payroll administration. If the personal budget is not be be increased to allow for this I see no point in being paid for this work if it takes away money we could use to provide a better level of care and wellbeing. It just diverts money away from what it is intended for.

    I cannot see why this would make more people take up direct payments. It makes no sense.

    It is bound to create issues for local authorities as it means more administration for them.

  17. Anonymous says:

    Whether or not there will be a larger take up of direct payments if a family /household member is paid for administration may well depend on the amount which is paid. The draft regulations mention the payment should be in line with that paid to a third party. However, it will be difficult for a family member to be able to get this information, very few third parties advertise their rates and the overall fee may be dependent on the number of hours of work that may be involved. We need to have access to this information. Even with a certain degree of financial and management skills a care package can take up a significant number of hours weekly. The individual family administrator will not be able to take advantage of economies of scale or administrative support available to a professional administrator.
    Any payments made will be subject to payroll, which may or may not add to the administrative burden and Carer’s Allowance will also need to be considered.

    I would like to see LAs form joint working parties with a number of family administrators to develop a clear policy, clear contract and a clear rate of remuneration. If this is done well it may well help to increase the take up of direct payments.

  18. Anonymous says:

    The take up of admin support for direct payments may be increased by allowing payments. However, this may be in direct relation to the amount that is paid. I understand this payment is to be made in addition to the budget for assessed needs, if not there is an issue of robbing Peter to pay Paul which may not be acceptable.
    The payment will have to be subject to be patrolled, which may or may not increase the administrative burden and the impact on Carer’s Allowance will need to be considered.

    The regulations call for the amount payable to be commensurate with that paid to a third party. There is no easy way for the family member to identify these rates, very few third parties, if any ,publish such information and often depend upon the amount of time to be spent on administration. Those of us with a degree of management/financial awareness spend a significant number of hours weekly managing the care package and we cannot benefit from economies of scale. I would like to see LAs consulting with a cross section of family administrators to develop a clear policy, clear contract and a clear rate to be paid. Those new to the Administrative role will not be able to readily identify how much time will be involved and those in a professional role have different economies of scale and support. An open clear policy will allow LAs and individuals to make a proper and informed choice about this aspect of Direct Payments.

  19. Anonymous says:

    Yes, it will increase uptake of direct payments. There is a significant amount of work involved in managing a large direct payment. This hasn’t been recognised in the regulations so far. Whilst I understand the concerns about people being paid for personal care through a direct payment, managing one requires a substantial amount of time and key skills. It makes most sense for this to be done by a family member who can micro manage the package and respond ‘in the moment’ to staffing issues, queries, supplies etc. It does not make sense for a large direct payment to be managed ‘remotely’.