Northern Ireland factsheet: Direct payments
Direct payments are cash payments given by health and social care (HSC) trusts to individuals who need community care services. To receive a direct payment, a person must have been assessed as needing services, and the payment must be used to purchase the services that the person is assessed as needing. This factsheet explains how direct payments work, and how to apply for them. This information applies in Northern Ireland. Different arrangements apply in England and Wales – for more information see factsheet 473, Direct payments.
What are direct payments?
The Carers and Direct Payments Act (Northern Ireland) 2002 empowers local HSC trusts to make direct cash payments to people for the community care services that they have been assessed as needing. Payments may be made to carers and to people with health conditions, including dementia. Trusts may arrange some services for a person as well as making direct payments to them.
In April 2004, it became mandatory to offer direct payments to eligible people requesting them. Trusts must consider every application to receive direct payments on its own merit. They cannot make one decision that covers all applications and requests involving people with dementia.
Direct payments do not give people an automatic right to a service. If the trust has a waiting list of people seeking a particular service, those wishing to pay using direct payments will still have to join this list.
Who can get direct payments?
Direct payments are available to a range of people (including disabled people, older people, those with enduring mental health issues and carers) who are over the age of 16 and have been assessed as needing certain services. Any person who receives direct payments must be willing and able to manage them – that is, look after the cash, find appropriate services and make payments (alone or with assistance).
Alzheimer's Society believes that if a person with dementia would prefer to use the direct payments system, then they should be supported to do so.
How can a person get direct payments?
A person with dementia or a carer can request a direct payment by contacting their local trust and asking for an assessment. Details for your local trust can be found in your local telephone directory, at your GP surgery, or through Health and Social Care in Northern Ireland (see 'Other useful organisations'). A social worker, care manager or social care assessor will then visit to discuss and assess the kind of support needed.
It can be helpful to write a list of the types of support needed before the assessment takes place – for example, a person may need help with cooking, eating, bathing and dressing. Keeping a diary for a week before the assessment can help to build this list.
If a direct payment is offered, the amount will be based on the number of hours of services needed, multiplied by an hourly rate. The hourly rates vary across the five HSC trusts in Northern Ireland. The rate offered by a trust may be higher or lower than the actual hourly fee required to pay for a particular service.
What can direct payments be used for?
A range of support services are available and direct payments can be used to buy all of the support that a person has been assessed as needing, or just part of that support. Each person's needs are different and it is important to discuss with a social worker what the direct payment will be spent on. The trust must also agree what the direct payment will be used for. The trust will need the person managing the budget to keep records.
There are a number of ways that direct payments can be used to meet someone's needs, such as:
- employing staff
- contracting people who are self-employed
- buying services from an agency.
The trust may agree to offer a combination of direct payments and services provided by social services, if this is what the person prefers.
For many people, the prospect of managing direct payments, particularly if this means becoming an employer, is quite daunting. Talking to someone who is already using direct payments can be helpful.
The Centre for Independent Living (see 'Other useful organisations') can also provide reassurance, support and independent advice on a wide range of matters relating to direct payments, including referral, assessment, finding staff, and managing money.
Are there restrictions on the use of direct payments?
Direct payments are made to fund services, and are not intended to be used for existing support networks within families and communities. For this reason, only in exceptional circumstances can direct payments be used to buy a service from the person's spouse or partner, or anyone who lives in the same household (unless that person is someone specifically recruited to be a live-in employee).
An individual should discuss their situation with the trust if they think that any person they would like to employ, or buy services from, might fall into one of these categories.
Capacity to manage direct payments
A trust will only offer direct payments to a person if it is satisfied that the individual is willing to receive the payments (gives consent) and is able to manage the payments (with help if needed).
If someone is not able to manage direct payments because they lose the capacity to do so, then the trust may continue to make payments as long as a suitable person is prepared to handle them instead. This person must be prepared to manage the direct payments and care package on a day-to-day basis on behalf of, and in the best interests of, the person. They could be (listed from most to least common):
- a carer or other family member
- another person deemed suitable by the local trust
- an attorney acting under an Enduring Power of Attorney
- an appointed controller.
Many people with dementia decide to nominate someone to assume Enduring Power of Attorney (EPA) on their behalf. The person makes the EPA in the expectation that, if they lose capacity, the appointed attorney will lawfully be able to deal with their property or affairs. (This will require that the attorney applies to register the EPA with the Office of Care and Protection. For details see factsheet, NI472, Enduring Power of Attorney and controllership.)
The situation is less straightforward for someone who has not made an EPA and has lost capacity, as they cannot give consent or manage direct payments. In these circumstances, the Office of Care and Protection may appoint a controller to manage the person's affairs on their behalf.
What can be done if things go wrong?
Anyone who is not happy with anything that the trust does should, in the first instance, contact their social worker, care manager or key worker. If these people cannot sort things out, the person can complain to the trust. Each trust has leaflets available on how to do this.
Complaints about agency workers or employed individuals should be taken up with the contracted service provider.
For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets
Other useful organisations
3 Lower Crescent
Belfast BT7 1NR
Provides information and advice for older people in Northern Ireland.
Centre for Independent Living NI – Head and Eastern Area Office
Beechill Business Park
96 Beechill Road
Belfast BT8 7QN
Organisation that works to support disabled people choosing to take more control over their arrangements for personal support. Provides services to people considering or using direct payments to employ staff to provide personal assistance.
Centre for Independent Living NI – Southern Area Office
Unit 10 Ulster Gazette Arcade
56 Scotch Street
Armagh BT61 7DQ
T 028 3752 2282
Centre for Independent Living NI – Western Area Office
Omagh BT78 1ES
T 028 8224 8926
F 028 8224 9878
Centre for Independent Living NI – Northern Area Office
The Business Centre
80–82 Rainey Street
Magherafelt BT45 5AJ
T 028 7963 4932
Vela Microboards NI Limited
A Vela Microboard is formed when a small group of committed family and friends join together with a person with an illness or learning difficulties to create a non-profit association to address the person's planning and support needs.
Carers Northern Ireland
58 Howard Street
Belfast BT1 6PJ
Charity that supports carers and provides information and advice about caring.
Department of Health, Social Services and Public Safety
The website has detailed information about direct payments. The following publications can be downloaded for free:
- A guide to receiving direct payments
- Direct payments policy and practice review report
- Direct payments legislation and guidance for boards and trusts
- HSS (ECCU) 01/2005 – Guidance on accounting and monitoring.
Health and Social Care in Northern Ireland (HSC)
The official gateway for health and social care in Northern Ireland, the website contains contact information for local trusts as well as information about services that are on offer.
Last reviewed: October 2011
Next review due: October 2013
Reviewed by: Ms Jane Buswell, Nurse Consultant, University Hospitals Bristol NHS Foundation Trust, Bristol and Dr Ann Capewell, Consultant Physician, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside
This factsheet has also been reviewed by people affected by dementia.
A list of sources is available on request.