Gov’t Advice: Flexible use of direct payments during the pandemic

Using your direct payment during the pandemic

While we’re all having to cope with COVID-19, the government expects Local Authorities (LAs) and Clinical Commissioning Groups (CCGs) to continue to give you as much flexibility as possible in how you use your direct payment. What matters most is that you are able to use your direct payment in a way that allows you to stay well and continue to get the care and support you need.

Where possible, you should keep using your direct payment as agreed in your care and support plan. But there may be situations where you need to organise your care and support in different ways as a result of the COVID-19 outbreak.

This is allowed. It has always been possible under the Care Act for you to use your direct payments flexibly providing it continues to meet your needs and keeps you safe. We expect LAs and CCGs to be as flexible as possible when you have made reasonable decisions to use your direct payment differently in a way that keeps you safe and avoids your care breaking down.

Ideally, you will have agreed this with your usual contact person at your LA or CCG, but we understand that this will not be possible every time. This is OK. The Care Act easements guidance says that LAs, providers and direct payment holders should work together to agree the circumstances in how the care package and direct payment can be used differently, without needing sign-off.

Many LAs and CCGs have also now written their own local guidance on how direct payments can be used during the pandemic. If you can access the internet, it’s worth looking at their websites to find advice and support.

When you have to adapt or change your care and support because of COVID-19, you should make a note of what you have done and why and keep any receipts or evidence of how you have used your direct payments. You may need this for future reviews.

Example scenario 1

Joy receives a direct payment that she uses to fund counselling sessions and activities in the community, to support her mental health. The payment helps to reduce isolation. As a result of coronavirus and social isolation, Joy is no longer able to receive counselling, nor can she engage in community activities.

Joy contacted her direct payment support service saying she was feeling vulnerable, anxious and isolated living alone during social isolation. They discussed with Joy how she might be able to feel less isolated, and during the discussion it emerged that she did not have access to a computer.

Joy agreed that if she had one, she may be able to have online sessions with her counsellor, could communicate with friends through a video call, and would have access to more leisure opportunities through the internet.

Together, they drew up a plan for Joy to approach her social worker, proposing that she used her budget more flexibly and bought a laptop. Joy’s social worker was very receptive to the idea and approved it. Joy also received training on how to use her laptop through an online tutorial – supported to do this by Joy’s social worker.

Receiving her laptop has changed Joy’s life during the lockdown. Her anxiety and stress levels have fallen dramatically, and she has managed to restart her counselling sessions via video call. This was achieved at no additional cost but has changed Joy’s life and improved her health and wellbeing.

Example scenario 2

Zeenat and Eoin both have autism and receive direct payments to support their wider care needs.

The couple usually enjoy visiting their local pub each day for their favourite meal, which they pay for themselves. When the pub closed as a consequence of the COVID-19 pandemic, Zeenat and Eoin became increasingly concerned and anxious as they could not do this anymore.

Despite having closed, the pub’s landlord kindly offered to continue making Zeenat and Eoin’s favourite meal and leave it on their doorstep. The local authority’s direct payments team agreed that Zeenat and Eoin’s direct payments could be used more flexibly to cover the cost of fuel for the pub landlord to deliver this.

This small change to the direct payment has allowed Zeenat and Eoin to continue to be able to purchase their favourite meal each day. As a result, Zeenat and Eoin feel much less anxious, and this has had a positive impact on their wider health and wellbeing.

Example scenario 3

Hadid is 13 and lives with his mum, dad and younger sister, Sabah, who is 9. Hadid has complex health care needs which means that his whole family are self-isolating.

The family usually have a team of PAs who support Hadid at home and support him when he is outside. However, due to Hadid’s health needs, the family think it would be too risky for his PAs to be coming into the family home. As a result, Hadid’s PAs do not provide that care and support anymore, and Hadid does not get outside as much as he used to.

This change to his life has led to Hadid being anxious about COVID-19. He is also missing his friends at school, who he cannot see anymore. Hadid’s family talk to their social worker about how they could use Hadid’s direct payment differently, that enables him to talk to his friends and manage some of his anxiety. Hadid’s social worker agrees to use some of his direct payment to purchase a games console that enables Hadid to play games online with his friends. Importantly, this allow Hadid to talk to his friends, using a platform that everybody else does.

Together, this has helped Hadid to manage and reduce his anxieties, as he can now talk to his friends when he wants, in a way he wants.

Using your unspent direct payment allocation (contingency funds) and accessing emergency funding from your CCG or LA

You may have a build-up of funds in your bank account, which your LA or CCG has agreed you can keep as a contingency fund, in case you need to pay for additional support at some point. If you need to use this funding due to a COVID-19 issue, you should keep a record so that this can be discussed at the appropriate time.

There may also be occasions where you need to request additional funding in an emergency because you do not have enough money to cover additional costs due to COVID-19. In these circumstances you should discuss this need with your LA or CCG immediately, who will consider this. Requests for additional emergency funding to prevent care breaking down will be prioritised.

Making payments to services you are unable to attend because of government policy (for example, day centres)

You are not required to make payments to services you are now unable to attend unless this is clearly stated in the contract you hold with the service. If this is the case, and you are required to make payments even though you do not receive the service, you should speak to your LA or CCG as soon as possible. They will help you to either make new arrangements, or provide additional funding to ensure that your care and support needs can continue be met.

Covering extra expenses faced by your PA during the pandemic (for example, car park charges if unable to use public transport)

In some circumstances, this will be appropriate, and necessary in order for you to receive the care and support you require during the pandemic (for example, if your PA cannot reach your home without using their own car, in cases where public transport is reduced). It is vital that you continue to receive the care and support you need to remain safe at home, and the government recognises the importance of support delivered by key workers such as PAs.

As an employer, you will need to consider whether the additional expense is essential, appropriate and cost-effective. If in doubt, or if additional funding will be needed, you should discuss this with your named contact at your LA or CCG.

Using your direct payment to pay for activities at home instead of in the community

If you’re unable to attend activities in the community as a result of COVID-19, it is possible to use your direct payment flexibly in a way that will similarly support you to achieve your health and wellbeing goals.

When you want to do this, and if you cannot speak to your LA or CCG about it, you should make a note of what you’ve done and why and keep any receipts or evidence of how you have used your direct payments as they will be needed for future reviews.

Example scenario 4

Miguel receives a direct payment, which he uses to attend a weekly art class at a local community centre. As a consequence of COVID-19, Miguel has been informed that his weekly arts class is temporarily suspended.

The organisation that usually provides the arts class has put learning materials and ideas on its website for people to try at home. Miguel feels it would benefit his health and wellbeing to have the opportunity to continue doing craft activities at home while the community class is suspended. However, he does not have the materials he needs at home.

Miguel contacts his direct payments support service, and with their support draws up a list of materials he needs to purchase. Together with the support service, Miguel finds online sellers and places an order.

The materials arrive and Miguel feels pleased he can participate in the activities suggested online. He continues to develop his skills and maintain his weekly routine. As a result, Miguel is experiencing less anxiety, and is more confident.

Continuation of direct payments

Continuation of direct payments during the pandemic

Your direct payment should continue as before. These remain as important as other types of provision, and LAs and CCGs should make every effort to ensure that budgets and payments are maintained and supported.

Using your direct payment differently because of rules around isolation

In some exceptional cases, the care and support you usually receive may need to change given current government guidance and rules around isolation. For example, if your care and support included going to community classes, this might no longer be possible. Care and support may need to be met in a different way, such as accessing exercise classes through technology, rather than in community settings.

The direct payment guidance encourages LAs and CCGs to provide you with longer-term payments (for example, 2 months’ money rather than one), and therefore you may receive a different amount of money compared to usual. Others are providing extra funding within the direct payment, to cover contingencies. If this does happen, you will be told in advance.