Choosing care: A brief guide to Direct Payments

We are incredibly fortunate to live in a country wherein healthcare is highly accessible, often at little or no upfront cost. But as needs become more specific, taking care into your own hands can allow more flexibility in choosing the specific kind of service required, and that’s where Direct Payments may be suitable for you


Once the provision of care services is deemed necessary following a care assessment, a ‘Personal Care Budget’ will be decided on. This can be used to fund council-provided care services, or one can opt for Direct Payments if they’d rather arrange these services themselves (though they cannot be used to fund permanent residential care).


Before deciding that Direct Payments are suitable, first assess the services your council is able to offer, and whether they are sufficient for your needs. If they are, taking them up may be the simplest option. Be aware that having control over Direct Payments requires a fair amount of paperwork and financial savvy- which the recipient may not be in the most ideal position to take responsibility for. Help managing the monetary records can be arranged by your council, and the responsibilities can be passed to a more capable individual if necessary- known as the ‘nominated person’. Similarly, if the payments are to go to anyone other than the recipient of care, due to lack of mental capacity for example, they become the ‘authorised person’ and must be deemed suitable by the local authority. Having power of attorney agreements written up will be hugely helpful if a relative becomes incapacitated.

If the spending records and budget are not maintained probably, one runs the risk of having to reimburse the costs to the authority. The payments are also means tested, and though the budget should cover the level of care you need, the amount may need topping up with your own funds to afford your ideal package of services. The Local Authority have a duty to provide the best value care, and if the same needs can be satisfied at one particular cost, it is unlikely they will pay out for any more expensive options. Though the local authority is not able to sell its own services to you, you are able to make use of those they provide for free (such as reablement, which has no cost for up to 6 weeks provision).

Once you have chosen to opt for Direct Payments, you will sign an agreement. This will lay out the means by which you shall record the expenditure- primarily to prove that you are spending it on care and not luxuries or other unauthorised services. The payments will be paid monthly into your bank account, and it is advisable to set up an account specifically for them. You will then have to decide what kind of service to pay for. There are essentially 3 choices- become an employer of a carer, take on a self-employed carer, or pay an agency to provide a carer. Using HMRC’s online checker can be useful for determining the status of the employee if unsure. It is common for family member to take on the carer role, but there can be some complications when approving them for Direct Payments- especially if they reside in the same household (a ‘close family member’).  It will also result in the loss of any Care Allowance or support services that were previously granted.

In situations wherein a close family member takes on the responsibility as full-time carer, ‘Gratuitous Care Payments’ are likely to be given the green-light before Direct Payments. These are generally authorised for close family members who give up work to care, and are capped as to prevent profiting. The Local Authority will decide on whether this is an appropriate choice.The switch from family-member to employee brings with it a shift in the relationship’s dynamics, and this must be respected by both sides.

It is the responsibility of the local authority to focus on the impacts and outcomes of the proposed care- not to act with only the financial matters in mind. Becoming an employer may provide the most control over the services you pay for, but utilising an agency may be the simpler route to your desired care package if the prospects of familiarising yourself with employment law is daunting. If the Direct Payments system becomes no longer suitable, you are free to stop at any time and make use of council-provided services. We recommend making use of forums such as Carers UK and to interact with other users of the Direct Payments service.

Direct Payments can be empowering, and facilitate the unique care package the recipient requires. There are additional responsibilities and complications involved, but if handled properly they may be the ideal choice. In our next post, we will look at the steps you should take when preparing to take on an employee for the first time in order to create a safe working environment within the home.

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