Health and care services

Direct care payments to aid independent living

patient consultation

An insight into care service direct payments which are provided by Northern Ireland’s health and social care trusts.

A direct payment can be made from a local health trust to someone who has been assessed as needing personal social services, so that he or she can arrange for their own provision of care.

This system can help the individual lead a more independent lifestyle by making decisions on care issues affecting them. The payment enables the recipients to decide how and when their needs will be met by directly employing someone or using an agency worker.
A direct payment could work for a person who needs a home-help but finds that, due to the demands on resources, the trust does not have anyone free at the date and times required.

The person could use the payment, for example, to directly hire a home-help to come at suitable times. The payment user has more control over the services needed, becoming an employer as a result – any problems with the services, the way it is arranged and how the money is used then become their responsibility. Guidance and support is available for anyone availing of the payment to ensure it is best used.
Payment is not provided for health services such as community nursing, speech and language therapy, or chiropody; or services provided by other organisations e.g. the Housing Executive.

The money is transferred to the recipient’s bank account and is available to:
• disabled people aged over 16;
• people affected by mental illness;
• older people who receive Trust services;
• disabled parents;
• parents of disabled children; and
• carers over 16 for services to meet their own needs.

An assessment is required to be considered for direct payments to establish the level of support needed. The first stage will work out the individual’s basic requirements. If they are complex, a more indepth assessment takes place.

If the trust concludes that personal social services are not needed, then direct payments cannot be offered. But, if needs or circumstances change, a new assessment should be requested. Also, if services were offered to an individual but were turned down, the trust may consider offering direct payments.

The trust should provide enough money to ensure adequate arrangements are made, according to the assessed needs. This includes any normal additional costs or responsibilities incurred as an employer. However, the trust needs to ensure value for money across all resources provided and may not meet the full cost of a certain service if an adequate alternative is available at a lower price elsewhere. In this case, the individual could be asked to pay the remaining balance. Records must be kept on how the money is spent as it remains public money and the Trust must keep track of how it is being used.

Payments are not an automatic right and the trust can only offer financial assistance if it is satisfied that the recipient is able to manage the service.

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