Adults direct payments
A direct payment is a cash amount you receive from Camden Council or the NHS trust so that you can arrange your own care and support, giving you flexibility and control over how your care is provided. With a direct payment, a person can live more independently because they receive care that is individually tailored to them and at a time that suits them.
More information about how you can use a direct payments is available below. Click on the links to take you directly to the relevant information.
- What a personal budget is
- Who to contact to find out more about direct payments
- Who may be offered a direct payment and what is the alternative
- What you can and cannot use a direct payment for
- Getting a direct payment set up and the steps involved
- What happens after you have received your first monthly direct payment
- Getting support to manage your direct payment
- Emergency situations and contingency planning
- If you need to be away from home for a while
A personal budget is the amount of money that is required to meet your eligible care needs, based on the care assessment, and agreed between you and Adult Social Care.
If you have received a care assessment from Adult Social Care and you are eligible for support, your Social Care Practitioner will work out a personal budget for you.
A personal budget can be used in a number of ways to provide someone’s care needs:
- Adult Social Care could manage the personal budget for you. This means we arrange the care and support based on your agreed Support Plan and review it with you to check you are happy with it
- The money can be paid directly to you or someone of your choice so that you or they arrange and buy the care and support you need. This is called a direct payment and it provides you more choice and control over how your care needs are met. By taking a direct payment, you are responsible for finding the care you want and paying for it. Also, how you use your direct payment has to be agreed in your Support Plan.
- You may have a mixture of the above – so, some money is given to you as a direct payment and the rest of the money Adult Social Care uses to arrange care and support for you.
Whichever way you choose to use your personal budget, social care is not free for everyone and some people need to pay towards the overall cost, depending on their financial circumstances.
Adult Social Care and NHS Mental Health Service can provide more information about direct payments.
1. If you currently do not receive support from Adult Social Care, contact the Access and Response Team for an appointment to discuss your care needs with a Social Care Professional.
Access and Response Team can be contacted on:
Tel 020 7974 4000 (select Option 1)
Textphone 020 7974 6866
2. If you currently receive support from Adult Social Care, contact the Locality Duty Team to speak to a Duty Social Worker to find out more about direct payments and how to receive them.
Locality Duty Team can be contacted on:
Tel 020 7974 4000 (select Option 1)
Textphone 020 7974 6866
3. If you currently receive support from Mental Health Services, contact your Care Coordinator.
4. If you would like to find about using direct payments to meet your mental health needs, contact Camden Primary Care Mental Health Network (CPCMHN) below for an appointment with a Mental Health Professional.
Camden Primary Care Mental Health Network can be contacted on:
Tel 020 3317 6806
5. Find out more about care and support for adults
Camden Care Choices provides social care and health information, support and advice to adults and their carers. It also provides a directory of local services and homecare agencies.
Mental Health Camden provides mental health information, support and advice to adults and their carers.
6. Find out more about direct payments
In Camden, People Plus is commissioned by us to provide independent support for people who use direct payments. You can contact People Plus to find out how direct payments can support you to meet your care needs.
People Plus can be contacted on:
Tel 0330 123 2815
This duty is provided in the Care Act 2014 which states that a direct payment may be offered to:
- Adults with a mental, physical or learning disability
- Unpaid carers of adults with a mental, physical or learning disability
- Adults who live in long-term residential care may receive direct payments for non-residential care services. For example, to try out independent living or for additional day activities.
Also, local NHS teams in England have a duty to ask an adult who is eligible to receive a Personal Health Budget if they would like their health needs to be met as a Personal Health Budget or met directly by NHS Continuing Health Care.
Adults that will not be offered a direct payment
In some circumstances, an adult will not be offered a direct payment and these are set out in Schedule 1 of the Care and Support (Direct Payments) Regulations 2014.
An adult may not be offered a direct payment if they are:
- subject to drug or alcohol rehabilitation under section 209 or 212 of the Criminal Justice Act 2002
- released from prison on licence
Other adults who may not receive a direct payment are:
- Residents in care homes to fund their long-term residential care
- Previous recipients of direct payments who did not manage their direct payment well
The alternative to direct payments for adults
A direct payment is one way for a person to receive their personal budget.
In some circumstances, Adult Social Care may decide that direct payments is not the appropriate option. If this is the case, your Social Care Professional or Health Care Professional will give a reason for the decision.
The alternative to receiving direct payments is a care package that we arrange to meet the care needs agreed in your Support Plan.
The Social Care Practitioner or Health Care Professional will ensure your needs are being met by regularly reviewing your care.
If your circumstances change at any time, please contact the Social Care Practitioner or Health Care Professional so that your care can be reviewed.
Direct payments were introduced under the Care Act 2014.
Central to the Act is the principle of personalisation which recognises people as individuals with different strengths and preferences and putting the person at the centre of their own care and support.
1. Flexibility and choice
Flexibility, choice, and self-directed care are key to the principle of personalisation and this is what a direct payment is designed to provide. The Care and support statutory guidance (Chapter 12.35) states:
“Direct payment is designed to be used flexibly and innovatively and there should be no unreasonable restriction placed on the use of the payment, as long as it is being used to meet eligible care and support needs”.
In Camden we want direct payments to be used as flexibly as possible as long as it supports the person’s agreed outcomes in the Support Plan or Care Plan.
Camden’s strategy for living and ageing well, Supporting people, connecting communities reflects Camden’s commitment to the principle of personalisation where people are the experts in their own lives and can retain independence and live a good life as they have strengths and resources of their own.
This is known as a strength based approach. It means helping people to identify what matters to them and build upon their own strengths and resources to achieve that, so that they can be independent.
2. What direct payments can be used for
A direct payment must be used to pay for care as set out in your Support Plan or Care Plan and they are designed to provide a lot of scope as to how a person decides to meet their care needs.
What is appropriate use of direct payments to meet eligible care needs will vary from person to person, and it should always be in line with the outcomes agreed in your Support Plan or Care Plan.
Examples of what a direct payment can be used for are set out in the Care and support statutory guidance (Chapters 12.35 to 12.57):
- Employ staff to help with personal care and household tasks
- Pay a family member to provide administration support to manage a direct payment, where required
- Buy personal care from a private home care agency to be provided in your own home
- Buy short-term care in a care home for up to 4 weeks within a 12 month period
Other examples for what direct payments can be used for include:
- Attend evening classes or day activities
- Buy equipment for your home to enable you to live healthily and independently
3. Hospital stay
Being in hospital does not mean your direct payment will be suspended. If you employ a Personal (Care) Assistant you can continue to fulfil all your employment responsibilities whilst you are in hospital so that employment arrangements are maintained.
4. What direct payments cannot be used for
There are some things that a direct payment cannot be used for and they are set out in the Care and support statutory guidance (Chapter 12.35):
- Pay to live in long term residential care. Unless it is for non-residential care services such as daytime activities
- Pay for a service that your local authority itself provides, although purchasing a service that the local authority commissions is allowed
- Employ co-habiting family members to meet your care needs, unless the local authority agrees it is necessary
Other things that direct payments cannot be used for are:
- Paying household bills and daily living expenses e.g. utility bills, rent or mortgage, and food shopping bills
- Buying health services such as the dentist or chiropody or equipment from the NHS
- Paying for gambling and prostitution
- Anything that is illegal
- Paying for travel and accommodation cost for holidays
- Anything that is not related to meeting eligible needs as agreed in your Support Plan or Care Plan
If you have any queries about how a direct payment could be used to meet eligible needs as agreed in your Support Plan or Care Plan, please contact your Social Care Practitioner or Health Care Professional.
If an agreement needs to be reached regarding use of a direct payment, this will be decided jointly by a Team Manager and Service Manager in Adult Social Care or Camden & Islington NHS Trust.
Setting up a direct payment may seem a lot of work, but there are good reasons for having one as it enables you to choose who provides your care and when.
When an adult receives a Care Assessment or Care Review, the Social Care Practitioner will discuss direct payments as an option for meeting eligible care needs.
In Camden, the steps for setting up a direct payment are as follows.
Step 1. An assessment of your care
The purpose of a care assessment is to identify and agree what support is required to meet eligible needs and what the personal budget is.
A care assessment is carried out by the Social Care Practitioner or Health Care Professional with the adult who has support needs and their carer if they have one.
The Social Care Practitioner or Health Care Practitioner will then develop a Support Plan that sets out what are the agreed outcomes or goals you wish to achieve.
Detailed information about an adult care assessment is available in guidance titled ‘How Camden ensures care is of a good quality, including care reviews.
Step 2. A financial assessment
Social care that is provided by the local authority is free for children and young people under 18. But it is not free for every adult. If you are aged 18 or over, the Social Care Practitioner or Health Care Professional will inform you about a financial assessment that needs to be completed.
The purpose of a financial assessment is to determine whether you are required to contribute an amount towards the cost of your care.
After the financial assessment is completed, Adult Social Care will confirm with you if you are required to contribute and how much.
For further information about the financial assessment process in Camden, a downloadable PDF titled ‘Paying for non-residential care’ is available on Camden Care Choices.
Further information about charging and financial assessments can be found in the Care and support statutory guidance (Chapter 8).
Step 3. Discussion about direct payments
At this point, the Social Care Practitioner or Health Care Professional will discuss direct payment as an option for meeting your care needs. They will explain briefly what is involved in receiving a direct payment and how you would be able to choose care services to purchase or employ a Personal (Care) Assistant.
More information about setting up a direct payment and what it can be used for can be explained in more detail by People Plus. People Plus specialises in providing direct payment support and they are commissioned by Adult Social Care.
If you wish to receive direct payments or find out more about what is involved, the Social Care Practitioner or Health Care Professional can refer you to People Plus after the financial assessment is completed. People Plus will then contact you to run through the setting up process.
Depending on how you wish the direct payment budget to be used to meet your agreed outcomes, People Plus will discuss and identify what services could be purchased, or whether community services may be able to meet some outcomes, or whether you could employ a Personal (Care) Assistant to provide your care.
If you wish to employ a Personal (Care) Assistant, People Plus will explain what that involves and support you with the recruitment process, and how to develop a good employer and employee relationship and ensure the quality of care provided is to a standard you expect.
If you agree to use direct payments in the ways discussed with People Plus, People Plus will include those details in your Support Plan or Care Plan.
Step 4. Setting up payment methods
People Plus will discuss with you and support you to set up payment methods and explain what the options are. They will also support you to complete the necessary paperwork that is required.
There is more detailed information about this step in the guidance titled ‘ Support available from the commissioned Support Service (People Plus)’.
Step 5. Getting the funds transferred into your account
People Plus will then provide the Social Care Practitioner or Health Care Professional with a summary plan of what has been agreed regarding how the direct payment will be used, along with the start date.
The agreed summary plan will be recorded on the Adult Social Care record management system.
The Social Care Practitioner or Health Care Professional will notify the Direct Payment team who are responsible for ensuring the funds are transferred to individual accounts.
The Direct Payment team will write to you or your carer and confirm your details are on the payment system and advise you of your weekly amount, the start date, and information about how to manage your direct payment, how we check your direct payments and what your responsibilities are.
The funds will then be transferred to your account or your carer’s account in the next payment cycle and each month thereafter.
1. Ongoing support available
People Plus will continue to provide support on an ongoing basis and throughout the time you receive direct payments.
Examples of ongoing support from People Plus includes:
- provide information and advice to ensure you are receiving good quality care
- identify services or signpost to services that can support you to meet your agreed care needs
- depending on what method you are using to make purchases from your direct payment, People Plus will support you submit paperwork that is required as part of our checking process
2. Six-week review if you are new to receiving support from Adult Social Care
If you are new to receiving support from Adult Social Care, 6 weeks or thereabouts after your direct payment has started, People Plus and your Social Care Practitioner or Health Care Professional will get in touch with you to see how you are getting on with your direct payment and answer any questions you have.
3. Checking your direct payment
When your direct payment was being set up, People Plus would have explained that the purchases you make with your direct payment may only be for the needs agreed in your Support Plan.
The Direct Payment team is required to ensure that direct payments are used properly and they will regularly check your direct payment account and raise any spending issues with the Social Care Practitioner or Health Care Professional.
4. Annual review of your direct payment
A formal review of your direct payment takes place regularly, usually annually or just after a year, to check you are continuing to receive good quality care and that care arrangements are working well.
The review will include a discussion to check that the funds are used in the way that it was designed, including:
- any risks to your safety and welfare in regards to taking a direct payment. This is for safeguarding purposes to prevent any potential abuse to people who use a direct payment
- how the financial and business side of your direct payment is going and any amounts that have not been spent.
As the review is part of your annual Support Plan or Care Plan review, it will also be an opportunity for everyone involved in your care to:
- understand any changes to your health or social care needs
- give their views on how well they think your care is being met, including views from carers, families, advocates
Further information about a care review, such as what to expect and who is involved in available in guidance titled ‘How Camden ensures care is of a good quality, including care reviews’.
Having a direct payment also involves administration tasks and managing the finances, such as dealing with invoices and ensuring services or staff that you employ get paid.
The finance and administration tasks may seem daunting and there is support available to help you manage them.
1. How a Managed Payroll company can support you
If you wish to employ a Personal (Care) Assistant, there are legal responsibilities that need to be met such as submitting tax returns to HM Revenues and Customs and other tasks such as calculating tax and NI, and paying staff wages. These tasks and many others related to the day to day management of employing staff can be completed by a Managed Payroll company.
Managed Payroll companies charge a small fee but they will save a lot of time and trouble in the long run because it takes on the full administrative responsibility of making payments. In any case, employers are strongly advised to use a Managed Payroll company.
Further information about Managed Payroll companies can be provided by Personalisation Support in Camden who may be able to provide contact details of companies that other direct payment recipients in Camden are using.
2. How a trusted family member or friend (Suitable Person) could support you
If you wish to receive direct payments, regardless of whether you employ a Personal (Care) Assistant, you may nominate a Suitable Person to manage the day to day administration of your direct payment.
The Care and support statutory guidance (Chapter 12.14) provides more information about what the nominated Suitable Person could support with.
The Suitable Person may be a trusted family member, partner, a close friend, carer, someone appointed by the Court of Protection, or appointed under the Lasting Power of Attorney. The person you employ as a Personal (Care) Assistant cannot be a Suitable Person.
The Suitable Person would administer the funds, such as deal with invoices and make payments for services you have received. If you employ staff as part of your direct payment, the Suitable Person would also take on the legal responsibilities required of an employer. Although the Managed Payroll company that you use would ensure payments are process, they would receive instructions from the Suitable Person in regards to paying services and people.
To ensure the Suitable Person understands what their role involves, the Direct Payment team will talk through the process with them and they would be required to sign a Direct Payment Agreement drawn up by Adult Social Care to confirm that they understand their responsibilities for receiving and managing the money on your behalf.
If a Suitable Person you wish to nominate is not a family member, relative, partner or close friend, they must first complete a check with the Disclosure and Barring Service (DBS). A DBS check is to see if someone is fit to work with adults and children for safeguarding purposes. It enables people to make safer decisions regarding whom they recruit for paid or voluntary work. People Plus will be able to tell you more about how to get a DBS check.
To find out more about nominating a Suitable Person to manage the financial side of your direct payment contact your Social Care Practitioner.
3. How the commissioned Support Service, People Plus can support you
As part of the Direct Payment service, there is independent specialist support available to help you manage your Direct Payment. The service is commissioned by Adult Social Care and it is for anyone who receives a direct payment, including their carers and families.
The specialist support service can help with getting your direct payment set up, provide ongoing support the whole time you receive direct payments, and make the whole process as simple as possible for you.
The support is provided by People Plus. Their contact details are:
Email - firstname.lastname@example.org
Phone – 0330 123 2815
Further information about the support that People Plus provides is available in the guidance titled ‘Support provided by commissioned Support Service (People Plus)’.
Direct payments are to enable people to live as independently as possible with solutions that are tailored to meet their needs.
In an emergency such as the Coronavirus pandemic when people were asked to prepare for periods of self-isolation, living as independently as possible became more important than ever.
The Coronavirus pandemic required everyone to adapt to living and working in a challenging environment with changing needs and uncertainty. Also, it demonstrated the importance of creating a contingency plan in case of an emergency.
A contingency plan could include the following information:
1) Who to contact for support
Phone 0330 123 2815
Camden Adult Social Care Access and Response Team
Phone 020 7974 4000 (option 1)
Camden Mental Health Crisis Team if you receive Section 117 After Care
Freephone number: 0800 917 3333
If you receive NHS continuing healthcare, contact:
Your Care Coordinator / Healthcare Professional, or Camden Primary Care Mental Health Network (CPMHN) on
Tel 020 3317 6806
2) A list of support tasks
Make a list of tasks that need to be completed every day or every week. It is easy to forget the little things. One suggestion is to do a ‘top to toe’ list. Get everything written down. For example, your regular Personal (Care) Assistant may know to wipe your glasses, but someone else may not think of it.
3) Your Support Plan or Care Plan
Check your Support Plan or Care Plan is up to date and that appropriate people have a copy. If you don’t have a Support Plan or Care Plan, produce a one-page document of the basic information people may need about you and your support needs.
4) Emergency contact list – make sure people on the list know you may need to call them
Make sure you have the contact details of people or organisations you may need to get in touch with such as your Social Care Practitioner or Health Care Professional and contingency care agency. Make sure this list is complete and up to date and that everyone on the list knows that you, or someone else, may call them.
5) Plan ahead
If you employ a Personal (Care) Assistant, talk to them in advance about how you might manage in an emergency situation, such as if one of your Personal (Care) Assistants was required to self-isolate. If you have a team of Personal (Care) Assistants, how might they change their working rota to cover absences.
Find out about your legal obligations as an employer and speak to People Plus for advice.
Get your favourite foods in if you are getting low on them. You do not need to stockpile food. Make sure you have the medication you need and know where you can get supplies if you need them.
6) Use your direct payment flexibly
If you are self-isolating or concerned about using your external Personal (Care) Assistant for health reasons, you may be allowed to make temporary arrangements to let a family member act as your paid carer over a short-term period.
Please note that you need to get Adult Social Care’s permission before making such arrangements. If this is something you would like to consider, please contact your Social Care Practitioner via the Access and Response Team.
The Adult Social Care Access and Response Team can be contacted at:
Phone 020 7974 4000 (option 1)
There may be times when you will need to be away from home for a while, such as being admitted to hospital, a short stay in a care home, going on holiday, or travelling abroad.
1) Hospital admission
If you are admitted to hospital, we will pay for your direct payment for up to 4 weeks from when you began your stay in hospital.
If you employ a Personal (Care) Assistant and your hospital stay is longer than 4 weeks, your direct payment may be suspended. You should seek advice from People Plus about how you can meet your legal obligations to the Personal (Care) Assistant that you employ.
2) Short-term stay in a care home
In Camden, a direct payment cannot be used to pay for people to live in a care home long term. However, short stays in a care home can be funded by a direct payment, for example to provide a respite break for a carer.
The Care and support statutory guidance (Chapters 12.41 to 12.45) defines a short stay as not longer than 4 consecutive weeks in any 12 month period.
The guidance sets out that if additional short stays are made within a calendar year, the interim period between 2 stays is to be more than 4 weeks otherwise the 2 stays will be added together to make a cumulative total, and the cumulative total should not exceed 4 weeks if it is to be paid for with direct payments.
On the other hand, if 2 stays in care homes are more than 4 weeks apart then the stays are not added together.
Once 4 consecutive weeks’ stay in a care home has been reached, no further stays may be paid for by direct payments until the next 12 month period. However, if each stay is less than 4 consecutive weeks, with a 4 week gap before the next stay, then direct payments can be used to pay for stays throughout the year because the 4 week limit is never reached.
A time limit is imposed because a direct payment is intended to promote people’s independence and encourage them to remain at home rather than moving into long-term residential care.
Further information about short-term care home stays paid for by direct payments is available in the Care and support statutory guidance (Chapter 12.41 to 12.45).
3) Going on holiday or travelling abroad
If you are going on holiday or travelling abroad, we may pay for your direct payment for up to 4 weeks in a calendar year as long as the following conditions are met before you have left your home:
- you have advised Adult Social Care you are going abroad and provided them the address you intend to stay at, a contact phone number, and the dates of your departure and return. If you do not return home on the expected date your direct payment may be suspended or ended which would result in a reassessment of your care needs
- you have demonstrated how you intend to meet your support needs while you are away. If you are going abroad, the differences in tax and Health and Safety regulations means it is generally not possible to use direct payments to pay for support or employ staff that are based in another country.
- the Personal (Care) Assistant agrees to travelling and supporting you while you are away from home
- you and/or the Personal (Care) Assistant agree to use your/their own personal funds to pay for the travel, including flights, accommodation and any other costs related to supporting you while you are away from home
- if you are taking your Personal (Care) Assistant with you, you and the Personal (Care) Assistant are covered by liability insurance, particularly while travelling abroad
- Health and Safety regulations are followed to ensure the working environment abroad is safe for the Personal (Care) Assistant to perform their duties
If there are exceptional circumstances for a person who receives direct payments to spend more than 4 weeks abroad in a calendar year, they should write to Adult Social Care. Adult Social Care will take into account of the current Support Plan and whether it identifies any care needs and spending more than 4 weeks abroad in a calendar year.