Some of these questions were asked by people who use mental health services and their carers at information events that have been organised by the Self Directed Support Service User and Carer Reference Group in Buckinghamshire.
1. Who will be able to have a personal budget?
Self directed support with personal budgets will be made available to mental health service users who are eligible for social care support. Eligibility for social care support will be based on an assessment of need usingFair Access to Care Services criteria (FACS).Only people eligible under FACS will be able to have a personal budget.
Fair Access to Care Services (FACS) is a national guidance from the Department of Health on eligibility for social care services. FACS identifies eligibility based on levels of need: critical, substantial, moderate and low. Buckinghamshire’s policy is to provide services to meet critical and substantial levels of need. FACS criteria should apply to all social care services.
The assessment carried out by the assessing practitioner of a community mental health team will establish the individual’s eligibility for social care money under FACS.
2. Does anyone not get allocated a budget?
Only people who have been assessed as not being eligible for Social Care Services will not be allocated a personal budget, however not everyone chooses or will be able to receive their allocated budget as a direct payment, in some instances the council or a third party will help to manage the money.
3. How can we ensure that the person being assessed can be supported by their family member or friend who knows the real situation?
The person themselves can decide who they want to be present at their assessment. If the person lacks capacity to partake in their assessment, the family’s views will be taken into account as part of the assessment.
4. My needs change; sometimes I’m well, sometimes I’m not. Sometimes I need services, sometimes I don’t. How will SDS support me?
Your care co-ordinator will assist you with your support plan, which will take into account that your needs may fluctuate at times. Receiving a personal budget under SDS should be able to give you more flexibility for times when you need increased support.
5.Having not had services for a while, how do I access an assessment?
If you are known to the Mental Health Services you can phone your CMHT and ask for an assessment. However if you are not known to services you will need to go to your GP in the first instance, who will need to work with you to decide whether a referral to the CMHT is appropriate at this time.
6. Will all mental health and physical disabilities be able to be taken into account?
The assessment under SDS will be integrated into your CPA assessment and will therefore be able to take fully into account all your health and social care issues including any physical disabilities you may have. If you require a specialist service from another service you will be referred to this as appropriate.
7. Can I have my needs as a carer assessed?
Yes, all carers are entitled to an assessment in their own right. Speak to your care coordinator about arranging a carer’s assessment.
Personal Budgets
8. Can a personal budget be used for health care services?
No. A personal budget can only be used for social care services. It is illegal to spend social care money on health care services. You need to be assessed as eligible for social care services in order to get a personal budget. The assessment may be carried out by a social worker, a community psychiatric nurse or an occupational therapist who works for one of the Community Mental Health Teams. Sometimes they are also called care co-ordinators.
9.How can you tell what’s a social care service and what’s a health care service?
In mental health services, social and health care services can seem interlinked. The practitioner carrying out the assessment of need will be able to advise on what is a social care service and what is a health care service. Social care services are provided to people to achieve social care outcomes like increasing someone’s independence or well being. Health care services are provided to people to achieve health outcomes like meeting a medical need or achieving better mental health.
10. When will Self Directed Support with Personal Budgets be implemented in mental health?
The Self Directed Support with Personal Budgets for people who are using mental health services in Buckinghamshire is due to be fully implemented by September 2011, which means that by then all new service users and all existing service users are expected to have a personal budget.
If you are currently in receipt of a service you will be assessed for Self Directed Support at your next CPA review.
11. Will everyone have to have a Personal Budget even if they don’t want them?
Everyone with an eligible social care need will eventually have a personal budget. However you can engage with self directed support as much or as little as you would like to. Everyone still has the option to ask their care co-ordinator to continue to arrange all support services for them or they arrange some or all of their support themselves. It’s the individual’s choice. No one is forced to take on more choice and control.
12.Will personal budgets mean carers have to provide more support?
Personal budgets should not result in increased demands on carers. The assessment will take into account how much support a carer is willing or able to provide. However, under Self Directed Support, the service user has the option to employ somebody they already know and pay them for the service they provide via a direct payment. The only rule is that the chosen person does not live at the same address, otherwise they would not be entitled to payment under Self Directed Support.
13.What can people spend their personal budget on?
There is no list of the kinds of services users can spend their personal budgets on as this will be different for everyone. Therefore your support plan will be agreed on an individual basis.Your support plan must meet your eligible assessed needs.
Your support plan must be:
- legal
- sustainable (so that it continues to provide ongoing support)
- Not put you (or anyone else) at risk
- Not be used to fund services which can be provided by another source (such as the NHS)
- Meet your needs in the most cost effective way (so it gives value for money)
Your plan for your social care support should talk about you and how the support you’d like will meet your assessed needs and outcomes. It should also show how you’d like to arrange your support so that you stay safe and well. Your care coordinator will work with you to make sure these plans are reflected in your mental health Care Plan.
Your support plan needs to be agreed by your care coordinator who will submit it for approval. If you are not happy with our decision you can discuss this with your care coordinator and ask for your support plan to be reviewed. Once your support plan has been agreed your personal budget will be made available to you.
14. Will there be an annual uplift to the budget?
No. Your needs will be reviewed at least annually and any adjustments would be made then.
15. Who can look after my personal budget if I don’t feel able to do this myself?
You can nominate an agent of your choice to receive your Personal Budget as a Direct Payment on your behalf (for example: spouse, son, daughter, sibling) by allowing them to be second card holders of the pre payment card – the method used for giving people their Direct Payment.
If you do not have anyone willing to do this you can ask the DPAS (Direct Payment Advisory Service) to receive the money on your behalf into a managed account. This will not mean that you are handing over choice and control to another person just that someone else will be receiving the Personal Budget and managing it for you. You can also ask your care co-ordinator to arrange the support directly for you, in which case you wouldn’t have to manage either the budget or the care arrangements.
Direct Payments and Charges
16. How do Direct Payments fit with Self Directed Support?
Direct payments are one way in which you can receive a personal budget as part of self directed support.
These are payments made to a person directly so they can arrange their own support, buying services from providers or employing their own staff. Although direct payments were available to you before the implementation of Self Directed Support, you will now have the possibility to spend your direct payment with a lot more choice and control on services that are able to meet your assessed needs e.g. by employing a Personal Assistant. You can receive part or all of your personal budget as a direct payment. Those people who do not feel comfortable to arrange their own support can choose to let their care co-ordinator continue arranging all or part of their support for them.
17. Is there support available to help people manage their direct payments?
Yes. In Buckinghamshire the council contracts DPAS (Direct Payments Advisory Service) to help people set up and manage their direct payment. DPAS can provide you with advice, support and information about recruiting staff, as well as advice on training and employment. DPAS also provide a payroll service for paying a personal assistant if you want this.
The Direct Payments Advisory Service
24 High Street
Prestwood
Buckinghamshire
HP16 9ED
Telephone 01494 862489
Telephone/Fax 01494 865368
Whatever type of support you decide to have, you can have help to set it up. Your care coordinator will be able to advise you about your options and where to get further help from.
18. How will charges work with Self Directed Support?
As soon as possible after the assessment of need, a financial assessment will be carried out. This will provide information to decide how much, if at all, a service user should contribute to their personal budget. People who ask the council to arrange their support will receive invoices (monthly bills) for their contribution. If the individual chooses to receive a direct payment, their payment will be reduced by the amount they are assessed as needing to contribute.
19. Will there be a limit to the financial contribution I may have to make?
You will have to undergo a financial assessment to determine whether you have to make a contribution to your care and this varies with each individual. However, we would never ask anyone to contribute more than the actual cost of care. A personal budget is not classed as a personal income; therefore it would not affect your benefits.
20. What is the monitoring process to justify how direct payment money has been used?
The preferred new method of getting a Direct Payment in Buckinghamshire is the Payment Card. This is a debit card issued by the RBS (Royal Bank of Scotland). With the Payment card the Council can monitor the account online. The card holder can register on line to view their account.
Service users are required to keep receipts of their payments in case the Council needs to check that the Direct Payment has been used correctly.
The RBS will also send regular Statements to the service-user so that they can check their expenditure.
For further information on the payment card please follow this link:https://www.buckscc.gov.uk/assets/content/bcc/docs/adult_social_care/payment_card.pdf
Support Planning and Putting things in Place
21. Will Self Directed Support mean I have to change the services I currently get?
No. You do not have to change your service if you are still eligible for support and are happy with the support you receive.
22. Will new services be available for people to buy using their Personal Budgets?
As use of personal budgets increases, the market of social care services is likely to change as people choose different kinds of services. However, these changes will not happen overnight. The commissioning team within social services are looking at the social care service market and are working with providers to encourage new and more flexible services.
23. Who will be available to help people with planning their support?
The person’s care co-ordinator who has completed the assessment can help as can a carer, family and friends or an advocate. In Buckinghamshire, the person will in the future be able to get involvement and support from a “broker”. This is a person who specialises on helping people to do their support planning by helping them to find out what services are available and how it is best to spend their personal budget. Buckinghamshire County Council are currently in the process of developing this brokerage service.
24. Will carers be involved in the development of support plans?
Yes if they want to be. Carers are also offered a carers assessment to look at their needs.
25. Can people change their support plans?
Yes. You should ask for a review and can do this at any time if you feel your needs have changed and/or your support no longer meets your needs.
26. Do people have to have a Direct Payment to access different kinds of services?
Currently there are some restrictions on what services the council can buy. This means people receiving direct payments may find they are able to access a wider range of support than what is available through the council.
27. What happens with Self Directed Support if someone needs urgent help?
If someone needs urgent help, this might not be the best time for them to think about self directed support. In this case, we can arrange services on a temporary basis and then discuss self directed support with them at a later date when they are more able to consider this.
28. Where can I get a personal assistant from?
You can employ somebody you know as a personal assistant as long as they do not live at the same address as you. If you don’t know anyone you could employ as your personal assistant, the Direct Payments Advisory Service (DPAS) can assist you to find one. They will provide support to place an advert, shortlist and interview people. They will also provide help and guidance around all other aspects of employing somebody directly i.e. insurance, tax and payroll.
29. Who is responsible for CRB checks and checking references for Personal Assistants?
If you are employing someone privately you can ask the Direct Payments Advisory Service (DPAS) to complete CRB checks on the person you wish to employ. DPAS will also carry out any reference checks for you if requested and will assist with any or all of the recruitment process.
30. If I opt for a direct payment to employ people myself, who is responsible for sorting out National Insurance, liability insurance and tax?
It is your responsibility as an employer to ensure that any payments due to the inland revenue are made.
The DPAS (Direct Payments Advisory Service) can assist you to set this up. Your care co-ordinator can refer you to this service.
31. If I employ a personal assistant and they go off sick, what happens then?
Your care co-ordinator will help you to complete your support plan. Your support plan will have to take into account what will happen in situations when your personal assistant is off sick or on annual leave.
32. Can I pay family members to carry out the care for me?
Yes you can as long as they are not family members living in the same house as yourself. Any arrangements would have to demonstrate that they are in your best interest.
33. What if I do not want the hassle of arranging my own care?
You can ask your care co-ordinator to arrange your services for you.
34. How can you buy something that isn’t available yet e.g. how can we ask agencies to cater for our needs at certain times if they still run on the same system as before with the same staff situation? How will they be able to cater for us under SDS e.g. if people ask to be seen at the same time?
Under SDS providers may need to change how they operate or you may need to change your provider to one that can better meet your needs.
35. Will I get enough money via direct payment to keep my present care agency?
This is not guaranteed. It depends on the rate your agency is charging and whether they are willing to negotiate an affordable hourly rate with you.
36. What happens if the amount assessed does not match your current provision which meets your needs? Would you have to top up and if so what happens if you don’t have the funds to do so?
When you are assessed your personal budget will be calculated to enable you to meet your current needs. If you choose to use a provider that is more expensive than your personal budget can meet, then you are able to top up the difference. The council has the duty to meet your assessed needs in the most cost effective way and within the resources available to them.
37. What happens when a private agency wants to increase the cost?
All requests for increased costs would have to be negotiated with the provider by you or someone who can negotiate for you. If your personal budget is inadequate to meet your eligible care needs then you would have to discuss this with your care coordinator.
38. Can additional services be paid for from an Agency on top of the agreed services set out in the support plan?
Yes you can purchase additional care yourself.
Risks and Keeping you safe
39. How will the quality of care be monitored if people are arranging their own care?
Your care co-ordinator will check with you at your review that your needs are being met and that you are satisfied with the care you are receiving. If you are experiencing any problems with your care in between reviews you can contact your care co-ordinator or your local Mental Health Team.
40. Will Self Direct Support mean that people are put at more risk?
No. People’s support plans will identify any risks and how these will be managed. The support a service user receives will be reviewed regularly to make sure this continues to meet their assessed needs and any risks are managed.
Safeguarding procedures will apply whether the service user chooses to arrange their own support or they ask the council to arrange their support on their behalf.
41. Money given to people could result in an unsafe situation if that person has a mental health episode. What safeguards will be in place for this?
Cash given to someone would be in the form of a direct payment which should only be spent on the support identified in that person’s support plan. How a direct payment is spent is monitored through regular financial statements provided by that person or someone acting on their behalf, like a carer, relative or a friend. If a direct payment could put someone at risk, this would be considered as part of their care plan. It would also influence the decision to make a direct payment available to someone.
42. Who is going to regulate the carers that will be available to us, how can we make a good choice? What info will be available to us about agencies/carers to enable us to make a good choice?
Care agencies are regulated by the Care Quality Commission (CQC). Information about care agencies can be found on the CQC websitewww.cqc.org.ukor you can phone them on 03000616161. If you are employing your own carers through a direct payment they are not regulated as such but this will be discussed at your review with your care co-ordinator.
If you are employing carers privately then DPAS (Direct Payments Advisory Service) will be able to give advice and assist you with safe recruitment practises, which will include taking up robust references and undertaking CRB checks. Your care co-ordinator will refer you to DPAS.
43. Who will help if I have problems with my care?
If you are having problems with your care you can contact your care co-ordinator or your Community Mental Health Team.
