" Promoting individual well-being (1) The general duty of a local authority, in exercising a function under this Part in the case of an individual, is to promote that individual's well-being. (2) "
" How to meet needs (1)The following are examples of what may be provided to meet needs under sections 18 to 20— (a)accommodation in a care home or in premises of some other type; (b)care and support at home or in the community; (c)counselling and other types of social work; (d)goods and facilities; (e)information, advice and advocacy. (2)The following are examples of the ways in which a local authority may meet needs under sections 18 to 20— (a)by arranging for a person other than it to provide a service; (b)by itself providing a service; (c)by making direct payments. …"
" Assessment of an adult's needs for care and support (1)Where it appears to a local authority that an adult may have needs for care and support, the authority must assess— (a)whether the adult does have needs for care and support, and (b)if the adult does, what those needs are. (2)An assessment under subsection (1) is referred to in this Part as a "needs assessment". (3)The duty to carry out a needs assessment applies regardless of the authority's view of— (a)the level of the adult's needs for care and support, or (b)the level of the adult's financial resources. (4)A needs assessment must include an assessment of— (a)the impact of the adult's needs for care and support on the matters specified in section 1(2), (b)the outcomes that the adult wishes to achieve in day-to-day life, and (c)whether, and if so to what extent, the provision of care and support could contribute to the achievement of those outcomes. (5)A local authority, in carrying out a needs assessment, must involve— (a)the adult, (b)any carer that the adult has, and (c)any person whom the adult asks the authority to involve or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult's welfare. (6)When carrying out a needs assessment, a local authority must also consider— (a)whether, and if so to what extent, matters other than the provision of care and support could contribute to the achievement of the outcomes that the adult wishes to achieve in day-to-day life, and (b)whether the adult would benefit from the provision of anything under section 2 or 4 or of anything which might be available in the community. (7)This section is subject to section 11(1) to (4) (refusal by adult of assessment)."
" The steps for the local authority to take (1)Where a local authority is required to meet needs under section 18 or 20(1), or decides to do so under section 19(1) or (2) or 20(6), it must— (a)prepare a care and support plan or a support plan for the adult concerned, (b)tell the adult which (if any) of the needs that it is going to meet may be met by direct payments, and (c)help the adult with deciding how to have the needs met. (2)Where a local authority has carried out a needs or carer's assessment but is not required to meet needs under section 18 or 20(1), and does not decide to do so under section 19(1) or (2) or 20(6), it must give the adult concerned— (a)its written reasons for not meeting the needs, and (b)(unless it has already done so under section 13(5)) advice and information about— (i)what can be done to meet or reduce the needs; (ii)what can be done to prevent or delay the development by the adult concerned of needs for care and support or of needs for support in the future. (3)Where a local authority is not going to meet an adult's needs for care and support, it must nonetheless prepare an independent personal budget for the adult (see section 28) if— (a)the needs meet the eligibility criteria, (b)at least some of the needs are not being met by a carer, and (c)the adult is ordinarily resident in the authority's area or is present in its area but of no settled residence."
" Care and support plan, support plan (1)A care and support plan or, in the case of a carer, a support plan is a document prepared by a local authority which— (a)specifies the needs identified by the needs assessment or carer's assessment, (b)specifies whether, and if so to what extent, the needs meet the eligibility criteria, (c)specifies the needs that the local authority is going to meet and how it is going to meet them, (d)specifies to which of the matters referred to in section 9(4) the provision of care and support could be relevant or to which of the matters referred to in section 10(5) and (6) the provision of support could be relevant, (e)includes the personal budget for the adult concerned (see section 26), and (f)includes advice and information about— (i)what can be done to meet or reduce the needs in question; (ii)what can be done to prevent or delay the development of needs for care and support or of needs for support in the future. (2)Where some or all of the needs are to be met by making direct payments, the plan must also specify— (a)the needs which are to be so met, and (b)the amount and frequency of the direct payments. …"
" Personal budget (1)A personal budget for an adult is a statement which specifies— (a)the cost to the local authority of meeting those of the adult's needs which it is required or decides to meet as mentioned in section 24(1), (b)the amount which, on the basis of the financial assessment, the adult must pay towards that cost, and (c)if on that basis the local authority must itself pay towards that cost, the amount which it must pay. …"
" Adults with capacity to request direct payments (1)This section applies where— (a)a personal budget for an adult specifies an amount which the local authority must pay towards the cost of meeting the needs to which the personal budget relates, and (b)the adult requests the local authority to meet some or all of those needs by making payments to the adult or a person nominated by the adult. (2)If conditions 1 to 4 are met, the local authority must, subject to regulations under section 33, make the payments to which the request relates to the adult or nominated person. (3)A payment under this section is referred to in this Part as a "direct payment". (4)Condition 1 is that— (a)the adult has capacity to make the request, and (b)where there is a nominated person, that person agrees to receive the payments. (5)Condition 2 is that— (a)the local authority is not prohibited by regulations under section 33 from meeting the adult's needs by making direct payments to the adult or nominated person, and (b)if regulations under that section give the local authority discretion to decide not to meet the adult's needs by making direct payments to the adult or nominated person, it does not exercise that discretion. (6)Condition 3 is that the local authority is satisfied that the adult or nominated person is capable of managing direct payments— (a)by himself or herself, or (b)with whatever help the authority thinks the adult or nominated person will be able to access. (7)Condition 4 is that the local authority is satisfied that making direct payments to the adult or nominated person is an appropriate way to meet the needs in question."
" 8 Care plan and care co-ordinator (1) Before a health body may make a direct payment, the health body must— (a)prepare a care plan in respect of the services to be secured for a patient by way of direct payments; (b)advise the patient, representative or nominee of significant potential risks arising in relation to the making of direct payments in respect of the patient, the potential consequences of the risks and any proportionate means of mitigating the risks; (c)agree with the patient, representative or nominee the procedure for managing any significant potential risk, and include the agreed procedure in the care plan; and (d)be satisfied— (i)that the health needs identified in the care plan of the patient can be met by the services specified in the care plan, and (ii)that the amount represented by the direct payments will be sufficient to provide for the full cost of each of the services specified in the care plan. (2) The risks mentioned in paragraph (1)(b) may in particular include— (a)risks to the patient's health; (b)medical or surgical risk arising from the procurement of a particular type of service; (c)risks arising from the employment relationship where direct payments are used to secure services from an employee; (d)risks arising from a provider of services secured by means of direct payments operating under an inadequate or no procedure for the investigation of complaints arising from the provision of the services; (e)risks arising from a provider of services secured by means of direct payments operating under inadequate or no insurance or indemnity cover for the services to be provided; or (f)a risk that monies paid by way of a direct payment may go missing, be misused or be subject to fraud. (3) A health body must nominate a care co-ordinator who is to be responsible for the following functions in respect of the patient— (a)managing the assessment of the health needs of the patient for the care plan; (b)ensuring that the patient or their representative has agreed to the matters listed in paragraph (7); (c)monitoring or arranging for the monitoring of— (i)the making of direct payments, and (ii)the health conditions of the patient in respect of which the direct payments are made; (d)arranging for review of the direct payments; and (e)liaising between the patient or the representative or nominee and the health body in relation to the direct payments. (4) A health body must in the care plan specify— (a)the health needs to be met by services secured by means of direct payments, and the health outcomes intended to be achieved through the provision of the services; (b)the services to be secured by means of direct payments that the health body considers necessary to meet the health needs of the patient; (c)the amount to be paid by way direct payments, and the intervals at which monies are to be paid; (d)the name of the person who is the care co-ordinator in respect of the patient; (e)who is to be responsible for monitoring each health condition of the patient in respect of which direct payments may be made; (f)the anticipated date of the first review mentioned in regulation 14(2)(a) (monitoring and review of direct payments) and how it is intended to be carried out; and (g)the period of notice that is to apply if, following a review under regulation 14(2)(a), a health body decides to reduce the amount of the direct payments or to stop making the direct payments. (5) The services that may be secured by means of direct payments exclude services— (a)arranged or provided under sections 83 (primary medical services), 84 (general medical services contracts) or 92 (arrangements by the Board for the provision of primary medical services) of the 2006 Act; (b)in respect of which a charge is otherwise payable by virtue of sections 172 (charges for drugs, medicines or appliances, or pharmaceutical services), 176 (dental charging) or 179 (charges for optical appliances) of the 2006 Act; (c)planned surgical procedures; (d)providing vaccination, immunisation or screening, including population-wide immunisation programmes; (e)provided under the National Child Measurement Programme; (f)provided as part of an NHS Health Check; (g)which consist of the supply or procurement of alcohol or tobacco; (h)which consist of the provision of gambling services or facilities; or (i)to repay a debt otherwise than in respect of a service specified in the care plan. (6) If a health body has considered including a particular service in the care plan as a service to be secured by means of direct payments but decides not to include that service— (a)the patient, representative or nominee may request the health body to inform them of the reason for the decision; and (b)the health body must inform them of the reason for the decision. (7) Before a health body may make a direct payment, the patient or their representative must agree— (a)that the patient's specified health needs can be met by the services specified in the care plan; (b)that the amount of the direct payments is sufficient to provide for the full cost of each of the services specified in the care plan; and (c)that the patient's requirements may be reviewed in accordance with regulation 14(2). 9 Information, advice and other support (1) A health body must make arrangements for a patient, representative or nominee to whom direct payments are made to obtain information, advice or other support in connection with the making of direct payments. (2) The arrangements for information, advice or other support mentioned in paragraph (1) may include— (a)specifying the amount of a patient's direct payment and how this payment is calculated; (b)how a patient, representative or nominee can request a review of the patient's direct payment and care plan; (c)the circumstances in which a patient may no longer qualify for a direct payment; (d)the restrictions on how a direct payment may be spent; (e)the process involved in drawing up and agreeing the care plan; (f)provision for advocacy services, whereby a third party assists a patient, representative or nominee in relation to the terms of a care plan, or the management of any contract under which services secured by means of direct payments are provided, or otherwise; (g)provision for commissioning services, whereby a person assists the patient, representative or nominee in procuring services that may be secured by means of direct payments; (h)provision for payroll, training, sickness cover or other employment related services to assist a patient, representative or nominee where an employee provides services secured by direct payments for the patient; or (i)where the patient is also in receipt of a direct payment to secure relevant services for social care, information on integration of both direct payments and the arrangements between a health body and a local authority for joint working and co-operation. (3) If the care plan specifies a requirement for information, advice or other support, that support may be a service in respect of which direct payments may be made."
" Exemptions for certain activities in the public interest 1. Member States shall exempt the following transactions: … (g) the supply of services and of goods closely linked to welfare and social security work, including those supplied by old people's homes, by bodies governed by public law or by other bodies recognised by the Member State concerned as being devoted to social wellbeing; …"
"The supply of goods or services shall not be granted exemption, as provided for in points ( b ), ( g ), ( h ), ( i ), ( l ), ( m ) and ( n ) of Article 132(1), in the following cases: (a)where the supply is not essential to the transactions exempted; …"
" Group 7 — Health and welfare Item No … 9 The supply by— (a) a charity, … of welfare services and of goods supplied in connection with those welfare services. … NOTES (6) In item 9 "welfare services" means services which are directly connected with— (a) the provision of care, treatment or instruction designed to promote the physical or mental welfare of elderly, sick, distressed or disabled persons, (b) the care or protection of children and young persons, or (c) the provision of spiritual welfare by a religious institution as part of a course of instruction or a retreat, not being a course or a retreat designed primarily to provide recreation or a holiday, and, in the case of services supplied by a state-regulated private welfare institution, includes only those services in respect of which the institution is so regulated."
"12.2 Direct payments have been in use in adult care and support since the mid-1990s and they remain the Government's preferred mechanism for personalised care and support. They provide independence, choice and control by enabling people to commission their own care and support in order to meet their eligible needs. 12.3 Direct payments, along with personal budgets and personalised care planning, mandated for the first time in the Care Act, provide the platform with which to deliver a modern care and support system. People should be encouraged to take ownership of their care planning, and be free to choose how their needs are met, whether through local authority or third-party provision, by direct payments, or a combination of the 3 approaches."
"10.46 In developing the [care and support] plan, the local authority must inform the person which, if any, of their needs may be met by a direct payment (see chapter 12). In addition to this, the local authority should provide the person (and/or their independent advocate or any other individual supporting the person, if relevant and if the person wishes this) with appropriate information and advice concerning the usage of direct payments, how they differ from traditional services, and how the local authority will administer the payment (for example an explanation of the direct payment agreement or contract, and how it will be monitored). This advice should also include detail such as: · the ability for someone else (such as a carer) to receive and manage the direct payment on behalf of the person · the ability to request to pay a close family member to provide care and/or administration and management of the direct payment if the local authority determines this to be necessary · the difference between purchasing regulated and unregulated services (for example regarding personal assistants) · explanation of responsibilities that come with being an employer, managing the payment, and monitoring arrangements and how these can be managed locally without being a burden · signposting to direct payment support and support organisations available; in the area (for example, employment, payroll, admin support, personal assistants, peer support) · that there is no curtailment of choice on how to use the direct payment (within reason), with the aim to encourage innovation · local examples and links to people successfully using direct payment in similar circumstances to the person (providing these groups agree) · the option to have needs met by a mixed package of direct payments and other forms of support or arrangements 10.47 This information provided upfront should assist the person to decide whether they wish to request a direct payment to meet some or all of their needs and should also be available at various points in the process to ensure people have the best opportunities possible to consider how direct payments may be of benefit to them. However the person chooses to have their needs met, whether by direct payment, by the provision of local authority-arranged or directly provided care and support, or third-party provision, or a mix of these, there should be no constraint on how the needs are met as long as this is reasonable. The local authority has to satisfy itself that the decision is an appropriate and legal way to meet needs, and should take steps to avoid the decision being made on the assumption that the views of the professional are more valid than those of the person. Above all, the local authority should refrain from any action that could be seen to restrict choice and impede flexibility."
" Becoming an employer 12.48 Local authorities should give people clear advice as to their responsibilities when managing direct payments, and whether the person in receipt of direct payments needs to register with HM Revenue & Customs (HMRC) as an employer. Becoming an employer carries with it certain responsibilities and obligations, in particular to HMRC and people need to be aware of these before agreeing to take up a direct payment. Disability and tax - a guide provides information on being an employer. 12.49 The local authority should consider using the proportionality principle, whether to carry out checks to make sure any PAYE income tax and National Insurance contributions deducted from an employee's pay is in turn paid over to HMRC, and that employment payments do not breach the national minimum wage and conform to pension requirements if eligible. Some people may not need this check to be performed, but it may be more appropriate in other cases and conform to pension requirements if eligible. Where it becomes clear that payments, or returns detailing employee information deductions, have not been made, or that the individual is failing to meet their obligations as an employer generally, the direct payment scheme should be reviewed and consideration given to whether alternative arrangements that result in the direct payment recipient no longer acting as the employer need to be made. Not doing so may result in the individual building up arrears of tax and National Insurance due to HMRC, which may then lead to enforcement action to recover any debt. This situation should be able to be avoided by effective monitoring where appropriate, and by providing clear, accessible upfront information about the responsibilities of becoming an employer. Many local authorities have commissioned voluntary and charity organisations to provide support to direct payment holders on these matters. 12.50 Many people are interested in using the direct payment to become an employer, for example, directly employing a personal assistant (PA). In these instances, the local authority should ensure that the person is given appropriate information and advice that explains the difference between a regulated and unregulated provider to help the person make a fully informed decision on how best to meet their needs. Where a direct payment is made under section 32 of the Act and to comply with the regulations, the local authority must also ensure that the authorised person is aware of how to access Disclosure and Barring Service Checks (DBS - previously CRB checks) on individuals they wish to employ, for example by ensuring that a check has been made by the agency providing the service, the local authority, or by another body. Individuals cannot apply for DBS checks on other individuals, and the local authority should make people aware of this, and the importance of thorough checks and employment references in the recruitment process. 12.51 Where a person wishes to directly employ their own PA, the local authority should also have regard to the guidance published by Skills for Care detailing minimum levels of support for individual employers and PAs . This guidance recommends local authorities should provide on-going support through access to training activities in a variety of ways and promote the Workforce Development Fund. It also proposes that local authorities promote apprenticeships for PAs."
" Case Study: Making direct payments support accessible Abdul is a deafblind man; to communicate he prefers to use Braille, Deafblind Manual and email. He directly employs several staff through direct payments. He receives payroll support from his local direct payments support service. Abdul suggested ways to make direct payments management accessible to him. He communicates with the support service mainly via email but they also use Typetalk. At the end of the month, Abdul emails the support service with details of the hours that his staff have worked. The support service work out any deductions from pay (such as National Insurance and Income Tax) and email him to tell him how much he should pay the staff via cheque. They then send him pay slips to be given to staff. The envelope that the payslips are sent in has 2 staples in the corner so that he knows who the letter is from. The payslips themselves are labelled in Braille so that he knows which staff to give them to. Each quarter, the support service tells him how much he needs to pay on behalf of his employees in National Insurance and Income Tax. The service also fills in quarterly Inland Revenue paperwork. At the end of the year, the support service sends relevant information to the council, so that they are aware of how the direct payments are being spent. Abdul has taken on only some of the responsibilities of employing people; he has delegated some tasks to the support service. Control still remains with Abdul and confidentiality is maintained by using accessible labelling. In terms of the wellbeing principle, the local authority has promoted Abdul's control over his day-to-day life."
"63 Many local authorities have already commissioned support services for people with social care direct payments, and CCGs [clinical commissioning groups] may find it helpful to work with them to develop joint or integrated support services. CCGs may also want to consider consulting with and using the expertise of voluntary, user led, community, carers or peer support organisations when discussing or developing their ideas. 64 While support may be provided directly by the CCG, it may also be appropriate for people to purchase their own support, for example purchasing a payroll service to help when employing a care worker. This should be discussed within the care planning process and the care plan should specify any requirement for information, advice or other support. This can then be funded as part of the care plan, within which it must be costed and agreed in the same way as for any other service to be purchased by the individual."
" 7.2 Using a direct payment to employ staff 147 People may wish to use their direct payment to employ staff to provide them with care and support. CCGs should support them to do so whenever possible, while ensuring that there is appropriate practical support. 148 For some people who receive direct payments, it may be their first experience of being an employer, and it will be vital that there is good support available to them, if they want it. This support could include provision for payroll, training, sickness cover or other employment related services. There is further advice available from the Skills for Care personal assistant toolkit Employing personal assistants [1] . The personal health budgets toolkit includes guides and best practice examples including: · Options for managing the money · Personal assistants: delegation, training and accountability 149 Where direct payments are being used to employ one or more people, the person receiving care, the representative or the nominee, should be made aware of their legal responsibilities as employers. CCGs should ensure that individuals are fully aware of their responsibilities, and of any potential risks and should be supported to manage them (see paragraphs 106 to 113). 150 Concern about becoming an employer should not discourage people who would otherwise be willing and able to manage a direct payment. People should be informed of the local support available in relation to being an employer and the different options in relation to taking on staff, such as use of agencies. This should be done accurately and responsibly, making recipients aware of what is involved without overstating the extent and complexity of these responsibilities. 151 There will also be costs associated with employing a member of staff directly, such as National Insurance, training, insurance costs and emergency cover. When setting the budget and agreeing the care plan, CCGs should ensure that the full cost of employing someone is included, and people must not be expected to bear any of these costs themselves. 152 As one of a range of support services, individuals or CCGs may wish to include payroll services, which will take responsibility for administering wages, tax and National Insurance for direct payment recipients. If it is agreed that this should be paid for via the direct payment, the cost should be factored in when setting the budget."
"… it may also be appropriate for people to purchase their own support, for example purchasing a payroll service to help when employing a care worker. … This can then be funded as part of the care plan , within which it must be costed and agreed in the same way as for any other service to be purchased by the individual."
" 2.1.1 Care, treatment or instruction Care, treatment or instruction includes the protection, control or guidance of an individual when this is provided to meet their medical, physical, personal or domestic needs. Any instruction must relate to the care or treatment of the individual for example showing them how to dress or bath themselves. It does not include the supply of information in the form of advice or help to enable them make an informed decision. For a service to be exempt under this heading the following must be satisfied: · the recipient must be an elderly, sick, distressed or disabled person · the care, treatment or instruction must be part of an specific individual care plan and the service must relate to it · an assessment of the recipient's health condition and medical needs has been carried out by an appropriately trained person Examples include: · personal or nursing care (including assistance with bathing, dressing, toileting and other personal hygiene) · general assistance and support with everyday tasks such as form filling, letter reading or writing, bill paying · certain routine domestic tasks, see paragraph 2.1.2 · counselling · looking after or supervising vulnerable people · support or instruction designed to develop or sustain a person's capacity to live independently in the community · protection, control, guidance or companionship that is required to meet an individual's personal or domestic needs · residential care, including accommodation, board and other services provided to residents as part of a care package"
" Information, advice and other support (1) A health body must make arrangements for a patient … to whom direct payments are made to obtain information, advice or other support in connection with the making of direct payments. (2) The arrangements for information, advice or other support mentioned in paragraph (1) may include— … (h)provision for payroll, training, sickness cover or other employment related services to assist a patient … where an employee provides services secured by direct payments for the patient; …"
"It is important that people are allowed to be very flexible to choose innovative forms of care and support, from a diverse range of sources, including quality providers but also "non-service options" such as … ICT equipment, club membership and massage."
"Exemptions for certain activities in the public interest - 1. Member States shall exempt the following transactions: … (g) the supply of services … closely linked to welfare … work, … by … bodies recognised by the Member State concerned as being devoted to social wellbeing; …"
"Group 7 — Health and welfare - … 9 The supply by (a) a charity … of welfare services … NOTES … (6) In item 9 "welfare services" means services which are directly connected with (a) the provision of care, treatment or instruction designed to promote the physical or mental welfare of elderly, sick, distressed or disabled persons …"
"… the objectives pursued by the exemptions under [art 123(1)(g)], it is clear from that provision that those exemptions, by treating certain supplies of services in the general interest in the social sector more favourably for the purposes of VAT, are intended to reduce the cost of those services and to make them more accessible to the individuals who may benefit from them."
"It follows that the provision of services which, like those at issue in the main proceedings, are of such a nature as to improve the comfort and well-being of in-patients, do not, as a general rule, qualify for the [medical exemption]. It can be otherwise only if those services are essential to achieve the therapeutic objectives pursued by the hospital services and medical care in connection with which they have been supplied."
"34. In this case, it is common ground that the psychotherapeutic treatment given in Dornier's out-patient facility by qualified psychologists generally constitutes services provided to the patients as an end in themselves and not as a means of better enjoying other types of services. In so far as that treatment is not ancillary to hospital or medical care, it is not an activity closely related to services exempted under [the medical exemption]. 35. Accordingly, the Court of Justice finds that psychotherapeutic treatment given in an out-patient facility of a foundation governed by private law by qualified psychologists who are not doctors is an activity closely related to hospital or medical care within the meaning of under [the medical exemption] only when such treatment is actually given as a service ancillary to the hospital or medical care received by the patients in question and constituting the principal service."