What are the expectations around the flexible use of direct payments?
Direct payments offer a flexible way for people to arrange their own care and support. The Covid-19 pandemic is an exceptional situation where this flexibility could help ensure people continue to receive the care and support they need.
As far as possible, direct payments should continue to be used as agreed within the care and support plan. However, there may be circumstances during the pandemic where this isn’t possible, for example, through staff absence.
If this happens, individuals need to talk through with their social care or direct payments support team to work out how best to meet the individual’s needs. The flexibility of the response should take account of the Ethical framework for adult social care during Covid-19.
Things to consider:
- what could direct payments fund during the pandemic, so the individual gets the care and support they need?
- could restrictions on spend of the existing payment be reduced or suspended?
- is there a clear rationale that enables the individual to keep safe and prevent admission to hospital?
- can the care and support be delivered safely?
It’s still important for people who receive direct payments to keep receipts or evidence as they usually would and keep a record of how the money has been spent.
What might change about how direct payments are used, in the current context?
For some people, the way that they access care and support may need to change because of guidance and rules around social isolation. This will mean thinking about different ways to provide care and support for example accessing exercise classes through technology rather than in community settings or providing information and support to structure daily activities.
How care and support changes will need to be decided on an individual basis, but some examples people have told us about include:
- Personal Assistants (PAs) providing support over the telephone or video, for example Face Time or Zoom
- PAs initiating activities with a child over a big screen to keep in contact at regular times and on regular days
- PAs collecting and delivering shopping and medication
- PAs talking people through tasks remotely
- PAs self-isolating with direct payments recipients to provide continuous support, with the local authority providing additional beds
- PA supporting someone with maintain structure to their day by developing a timetable with a different activity every hour, which included meeting them at their home for a walk every day which gave parents a break.
Can people use unspent direct payments allocation or access emergency funding from the local authority?
Yes, direct payments give people the flexibility to vary the amount they spend from week to week and ‘bank’ any unused payment to use when needed, as long as the payments are used to meet the individual’s personal outcomes.
If an individual needs additional funding because of an emergency, such as equipment breaking, their local authority may help with emergency funding. Individuals should have been informed about emergency funding, and how to access it, when their direct payment was set up.
If the individual’s circumstances change significantly, then a new assessment may be needed.
Individuals should discuss this with their social care or direct payments team.
Individuals should keep receipts as they usually would and record how the money has been spent.
Continuation of direct payments
Given the pandemic, will direct payment be stopped?
No. The Covid-19 pandemic is not a reason to stop direct payments if an individual’s need for care and support hasn’t changed.
If an individual no longer wishes to use direct payments, they should speak with their direct payments team about how to end their arrangements. The local authority will then work with the individual to arrange their care and support.
What happens if the individual receiving direct payments is taken ill, self-isolating or admitted to hospital?
If an individual, or a member of their household, shows symptoms of Covid-19 they will need to follow guidance from Public Health Wales on self-isolating. The guidance states that individuals can continue to receive essential care within their home, with personal protective equipment (PPE).
This may be difficult if the people who usually provide care and support are in a vulnerable group or live with someone who is considered vulnerable to Covid-19. It may mean changing how they work or thinking about other ways to provide the care and support that the individual needs.
Unless it states in the Personal Assistant’s (PA) employment contract or is agreed otherwise, individuals need to pay their PAs for the time they would normally work but the individual is advising them not to. Local authorities will need to decide how they will manage payments if an individual asks their PA not to visit and might consider paying a retainer for PAs employed using direct payments while they are unable to work. In some areas, individuals have enabled the PAs they employ to support broader social care services temporarily, on a voluntary basis, which has been arranged by the local authority.
If an individual needs a temporary stay in hospital, the local authority may agree to continue Direct Payments so the individual can pay a retainer to ensure that PAs can get paid. The length of time this carries on for will need to be agreed. Retainers are useful to help keep PAs and so support a safe return home, as soon as possible.
Individuals who use direct payments to buy services should speak to the service provider and their local authority about suspending the service while they are in hospital, ill or self-isolating. The terms and conditions of their agreement with the service provider will show whether or not fees still need to be paid.
Where the reason for a stay in hospital means that an individual’s care and support needs have changed, this will mean their care and support plan will also need to change.
Can PAs support people in hospital, if they’re admitted?
A direct payment can’t be used to provide the care that the NHS is responsible for while an individual is in hospital. There may be some things that a PA can help with while an individual is in hospital, but this needs to be checked with the local authority. Many local authorities pay a retainer so that individuals can continue to employ PAs for short stays in hospital.
A PA may choose to visit an individual informally in hospital but given the current pandemic, this may not be allowed. Where visiting is allowed, PAs will be subject to infection control measures as is normal practice.
PAs have a vital role to play when an individual leaves hospital. It’s important that individuals receive up to date advice and guidance regarding a safe discharge from hospital that they can share with their PAs.
What about contingency plans?
Contingency plans help people to think about and understand what they will do if things change temporarily and at short notice. Making a contingency plan, or updating an existing plan, can help make sure an individual’s needs continue to be met if their current arrangements are disrupted because of Covid-19. Where individuals already engage with a direct payment support organisation, they may be able to provide support to develop this plan.
Contingency plans need to be agreed with the local authority where possible and used when needed.
Things to think about in a contingency plan include:
- Staffing - identify ways that PAs or services bought using direct payments can work differently if they can’t work in their usual way. This could include things like longer shift patterns and less frequent handovers.
- Alternative provision - when elements of care and support can’t be delivered (for example exercise classes in the community), explore other ways to do what’s needed (e.g. using on-line exercise classes, equipment or technology)
- Use of technology – direct payments could be used to support individuals to keep in contact with friends, family or PAs by purchasing equipment and supporting people to use it
- Alternative networks of support - consider identifying and contacting extended family, friends and/or volunteers to support individuals to stay safe and well at home. Be mindful that information, advice and training may be needed.
- Upskilling of existing staff - identify what possible additional training or support there is for existing staff members. This doesn’t necessarily have to be through face to face training, it could be through peer or e-learning.
Direct payments give a real opportunity for innovation and imaginative thinking about how a person achieves their personal outcomes. Each local authority will need to agree how flexible direct payments and support plans can be during the pandemic, including emergency or one-off payments, and how unspent direct payment allocation can be used.
Local authorities will need to account for the money that has been spent and so will need to have clear information to justify the payments, so it’s important that individuals keep receipts and record how the payments are spent during this time.
If care is provided by an agency, they should be contacted directly to discuss contingency plans, including if regular support workers are unable to work due to illness, template for a contingency plan.
Personal protective equipment (PPE)
Can direct payments be used to buy PPE for PAs?
If the existing direct payment contains funding to purchase PPE for PAs, this can continue.
If individuals or PAs can’t get PPE as they usually would, or the direct payment is not set up to fund PPE, then ask for assistance from the local authority who can help to get the PPE needed. The social care or direct payments support team can give advice.
Employment issues for PAs
Insurance providers have legal helplines and can answer queries regarding an individual’s employment responsibilities. ACAS [The Advisory, Conciliation and Arbitration Service] or UK or Welsh government are reliable sources of information on employment law.
What should people do if their PA is unwell or unable to work?
If a PA becomes unwell or needs to self-isolate, alternative arrangements will be needed to provide care and support to the individual. This could mean asking other PAs to take on more work. If that’s not possible, it will be necessary for the individual to put their contingency plan into action. This may mean family members stepping in to provide additional care and support, if the individual is happy with this and they are able and willing to do so.
If family or friends are not able or willing to do this and it isn’t possible to put the contingency plan into effect, the local authority will need to be informed. They can support the individual to develop a temporary plan that can meet the individual’s care and support needs while their PA is recovering, which could involve employing friends and family members if this enables them to achieve their agreed outcomes.
Some people who usually provide care and support might not want to go to work if they're afraid of catching Covid-19, especially if they’re in a vulnerable group, or live with someone who is considered vulnerable. They may be able to negotiate changing how they work or taking paid or unpaid leave if the individual who needs care and support agrees.
Are PAs eligible for sick pay?
Yes, they’re eligible if their average earnings are over £120 per week. They will be paid from day one rather than the fourth day of their illness. Employees and workers are eligible for Statutory Sick Pay (SSP) if they need to self-isolate because:
- they have Covid-19
- they have Covid-19 symptoms
- someone in their household has Covid-19 symptoms
- they've been told to self-isolate by a doctor or NHS 111.
PAs don’t need to provide evidence for their employers to be able to claim SSP for them. Employers will need to contact their payroll provider to make them aware of any sick leave taken, so that PAs can be paid the correct wages. SSP will be paid out through payroll and claimed back via HMRC. This refund will be for up to two weeks per employee. If a PA is self-isolating and then becomes sick, they should let their employer know by phone and not in person.
Can family carers or close friends be paid out of the agreed direct payment if PAs are not available?
Families and friends provide the majority of care and support in our communities. If a PA is not available, they may be able to step in and provide the additional care and support the individual needs on a voluntary basis for short periods. This can be identified in an individual’s contingency plan.
If the situation carries on for a longer period of time, the local authority may agree to payclose friends and family using direct payments. This would need to be discussed and agreed with the local authority.
There are some important factors to think about when deciding whether funding from existing direct payment should be used to pay family members and friends:
- routine employment and payroll processes will need to be followed, including adherence to agreed hours and pay rates
- whether any additional training and assessment of competence is required
- employment law issues related to the rights of existing paid PAs
- any additional costs involved if existing employees are entitled to ongoing pay
- the impact on any benefits the family member/friend already receives
- the impact on family member’s health and wellbeing and whether any unreasonable strain is being put on them
- if the family member is both the direct payment recipient and the employer, there can be a conflict of interest. In this instance, employment of the family member through an agency or third party could be a solution
- the impact it may have on relationships if the family member becomes an employee.
What is the government’s expectation on furloughing of PAs?
It’s not anticipated that the Coronavirus Job Retention Scheme will be used by many public sector organisations, as most public sector employees continue to provide essential services in response to the Covid-19 outbreak. The government consider PAs to be essential key workers, so furloughing them should be minimal.
Individuals who receive public funding through direct payments to employ PAs are expected to continue paying them, as direct payment are still being paid to the individual. This means that furloughing won’t be needed.
In a small number of cases, for example where it’s not possible for the PA to deliver the care and support required, and where they can’t be redeployed to assist with the coronavirus response, Coronavirus Job Retention Scheme may be appropriate. This brief guide to furloughing for employees and small firms may be helpful.
If an individual decides to stop PAs coming into their home, depending on their employment contract, the PA may be entitled to full pay. They’re not automatically entitled to be furloughed, as the work may still be available. Some local authorities are speaking to PAs about how they can use their skills to support social care and community services if they are no longer able to carry out their usual work.
General support on business questions can be found in government FAQs or over the phone on 0300 060 3000.
Can direct payments be used to cover additional expenses incurred by PAs during the pandemic - for example, car park charges if they’re unable to travel by public transport?
Direct payments support people towards achieving their personal outcomes and PAs are considered essential workers. The individual receiving direct payments will need to judge how appropriate and cost-effective it is to incur reasonable extra expenses. If in doubt, a discussion with the local authority should help to clarify what’s reasonable.
Anything that adds a cost to direct payments will need to be agreed with the local authority, including additional payments to PAs, family or friends providing care and support.
However, some decisions that enable an individual to stay safe and prevent admission to hospital need to be taken quickly, and individuals may not always be able to get hold of their local authority in time. If this happens, they will need to make decisions and provide a clear rationale for their decision, receipts and written evidence for how the money was spent retrospectively.
Given the social distancing measures, will all PAs have official documentation to show they’re doing essential work?
No, this isn’t needed but Social Care Wales has developed a social care worker card to help identify key workers. As key workers, PAs are eligible for these cards. The cards help identify key workers when travelling between places and access other benefits for key workers, for example protected shopping times.
The cards can be downloaded onto a phone or sent as a plastic card. We have asked local authorities to help us identify workers who aren’t registered with us who are eligible for the cards, including PAs.
If a PA does not yet have a card, they can ask their employer for a letter explaining the role they play and how this links to the guidance published on who falls into a key worker category.
Government guidance is clear that anybody is permitted to travel to and from work if it’s not possible to work from home. There is no special status for key workers in this respect. No documentation is required to prove that travel to and from work is necessary.
The definition of key worker is relevant in regard to accessing other provisions, such as care for children at local schools if they cannot safely be cared for at home. As key workers, PAs are eligible for this support.
What financial or employment support will I have?
Individuals who receive a direct payment should continue to receive the amount as agreed by their local authority.
The government has implemented a range of measures designed to support individuals who have direct payments, which include:
- implementing statutory sick pay (SSP) from day one
- legislation allowing small and medium-sized businesses to reclaim SSP paid for two weeks of sickness absence due to Covid-19
- deploying volunteers to support people at home.
Will direct payments budgets continue to be reviewed?
Yes, although during the pandemic, reviewing may not occur as frequently as it has previously. If someone is concerned that the amount allocated within the direct payment is not enough, or too much, they should get in touch directly with the local authority.
Are individuals expected to continue to evidence their spend?
Yes. As is normal practice, receipts or evidence that shows how the direct payment has been used should be kept.
People who fund their own care and support
What support is there for people who pay for their own care?
People who use their own money to employ a PA can follow the principles in this document around contingency planning, and health and safety. If individuals are unable to access the care and support they need, they should contact their local authority to discuss their care and support arrangements.
What should employers do if their PA refuses to isolate, when they have suspected coronavirus?
Individuals who have a PA showing symptoms of Covid-19 should immediately self-isolate in line with Government guidance. Under no circumstances should anybody showing symptoms continue to provide face to face care.
If a PA, or anyone who an individual has contact with, refuses to isolate, individuals should seek support from their local authority to enforce this.
What are the procedures for infection control in the house?
If PAs undertake cleaning duties, they should use the usual household products, such as detergents and bleach.
Personal waste (e.g. used tissues, continence pads and other items soiled with bodily fluids) and disposable cleaning cloths should be stored securely within disposable rubbish bags. These bags should then be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin for disposal as normal.
Dirty laundry should not be shaken before washing as this minimises the possibility of dispersing the virus through the air. Items can then be washed as usual, with all dirty laundry able to be washed in the same load. If using a laundrette, wait a further 72 hours after the 7-day isolation period (for individual isolation) or a 14-day isolation period (for households) has ended. Items heavily soiled with body fluids should be disposed of with the owners’ consent.
Direct payments insurance providers
General employment advice and support
- ACAS - Telephone: 0300 123 1100
- Citizen’s Advice Bureau - Telephone: 03444 77 20 20
- Department for Work & Pensions – Universal Credit - Telephone: 0800 328 5644
- Information about Personal Protective Equipment (PPE)
- Purchasing PPE in Wales - BCB International - Telephone: 029 2043 3700 / Email: Emily Howell email@example.com or Gabi Howell firstname.lastname@example.org.
With thanks to:
- Mark Cooper, Direct Payments Team, Flintshire County Council
- Zoe Williams, Independent Living Broker, Torfaen County Borough Council
- People who use direct payments who fedback to us
- Jody Mellor, Disability Wales.
For more information about see direct payments: a guide.