SECTION 7 MANAGING AND MONITORING SELF-DIRECTED SUPPORT
135. It is good practice to make payments in advance so that recipients are in a position to pay for the support they are purchasing. It is, however, up to local authorities to decide how frequently payments should be made. It is important that where self-directed support is financed from more than one local authority budget or other funding stream the individual receives one single payment to cover all the services he or she has been assessed as needing.
136. Local authorities will need to set up proportionate mechanisms that enable them to monitor payments which are made. Whatever the arrangements for payment, they will need to be reliable, as late or incorrect payments may put at risk the person's ability to secure the support they need. The local authority may also need to set up procedures for making additional payments in emergencies, for example, if needs change. Where payments are made directly to a bank account a written statement of the payment details should be sent to the individual for information.
137. People may receive as much assistance as they require to manage the money, but they remain accountable for the way it is spent. People may ask carers, family members, user controlled trusts, circles of support, peer support or other third parties such as support services to help them. Such support can be invaluable, whatever its source, and users may also choose to buy in assistance, for example using a payroll service from a local support service. There is no restriction on who may help a person in this way, although the restrictions on paying relatives already described will apply.
138. Where significant support is being provided, the local authority will need to ensure that any monitoring and review procedures involve direct contact with the individual for whom the payments are made, if necessary in the absence of the person who is helping them. This is to ensure that the individual is content with the way in which the money is being used. Both local authorities and individuals on self-directed support should also be aware of the potential conflict of interest if the individual secures services from the same person who is helping them to manage the payments. The same applies where an attorney or guardian intends to provide services for the individual.
139. Some people who initially need help to manage their self-directed support may in time be able to manage on their own. There is no restriction on the length of time that a person may receive help to manage their package.
Payments to a third party
140. With the individual's consent, the payments may be made to a third party but the person who gives consent to the payments must retain control over how they are spent. Self-directed support facilitates independent living, not a switch from dependence on the local authority to dependence on a third party. This means that people may express a preference about how a service is to be provided, and delegate the details to a third party so that they will not have to authorise every transaction. However, it must be open to the individual to overrule any decisions made by the third party. Local authorities should satisfy themselves that the relationship between the individual and the third party has been discussed and agreed before the package begins. They must also be satisfied that the individual is aware that they can receive the payments direct.
Management during periods of fluctuating health
141. Some people with fluctuating needs may only require help to manage their support at certain times. It is important that local authorities satisfy themselves that individuals have support in place when they need it. In these circumstances there is a need to plan ahead and make arrangements whereby a designated person or group of people - circle of support, trustees - can be given permission by the user to take over during a period when unable to manage. Having some form of advance directive should be considered an essential component. This would ensure that if they become ill they retain as much control and choice as possible of the arrangements and are able to regain full control if they become well again. This may help prevent a recipient reverting to local authority provision unless they wish this to happen. Advance directives make it possible for people with mental health support needs to state in writing what needs they have if they become particularly distressed or unable to manage. For example a person could write down what a support worker should do if they have a crisis, or write guidelines for how to assess risk, or provide a list of useful telephone numbers that the support worker could phone for advice or information if necessary 46.
142. If the person's condition is likely to deteriorate to the point where they are unable to manage even with assistance, the local authority might consider ways of enabling the person to plan in advance how this is managed, for example, a power of attorney. A back-up service controlled by the local authority could be set up and triggered during periods when the person is unable to manage. Equally, local authorities might decide to offer self-directed support to people whose condition means that they are likely, at some point in the future, to lose the ability to manage permanently. In those circumstances they will still need to satisfy themselves that safeguards are in place to alert them in such circumstances. People whose condition is likely to fluctuate or deteriorate permanently should be given an opportunity to explore any issues they may have about their ongoing ability to manage their package. In such cases the local authority should make it clear to the individual that they can decide to stop self-directed support at any time and receive arranged services instead.
143. Providing self-directed support, rather than arranging actual services, does not affect a local authority's function of providing emergency assistance under Section 12 of the 1968 Act or Section 22 of the Children (Scotland) Act 1995 ('the 1995 Act'). If the authority considers the circumstances to be so exceptional as to require such assistance, they may provide it in respect of the services to which the direct payments relate (see Section 12C (3) of the 1968 Act).
144. Local authorities should discuss with each person what arrangements they will make for emergencies. Local authorities should ensure that the person receives the support they need if the usual arrangements break down, for example, through sickness of one of the person's PAs. It is reasonable for a local authority to expect the person to have contingency plans and these should be clarified at the outset. However, if a local authority becomes aware that someone is unable to secure support to meet their needs, then their responsibility to arrange services for that person is the same as if the individual was not on self-directed support. The local authority may decide to step in, albeit temporarily, and arrange the necessary services, but it should first consider providing assistance to enable the person to continue to manage their own support.
145. Examples of contingency plans which people on self-directed support might make include making arrangements with independent agencies for emergency cover, or recruiting personal assistants who are prepared to work additional shifts at short notice when necessary. However, it remains possible that difficulties will arise which have not been anticipated and which cannot be covered by the arrangements the individual has made. In these circumstances, it will be helpful if the individual knows they can contact a named individual in the local authority or a local support service whom they can ask for help. Such contingencies should form part of the contract agreement.
Local monitoring of individuals' packages
146. There are two forms of monitoring that local authorities undertake for packages of self-directed support: monitoring of service and monitoring of finances.
147. Consenting to self-directed support for some aspects of meeting assessed need means the local authority no longer arranges services for that part of the package. It follows that the local authority will need to set up monitoring arrangements so as to satisfy itself that arrangements are meeting needs. Local authorities should discuss with recipients the information they will be expected to provide and the way in which monitoring will be carried out. Self-directed support should not begin until the recipient has agreed to any conditions which are necessary for monitoring purposes.
148. Care managers should not rely on individuals asking for help, particularly when someone begins on self-directed support for the first time. Regular reviews should be arranged to discuss how the package is working. A local independent support organisation or independent advocacy service may help some people raise any issues which are giving concern.
149. Packages which include health services will require to be monitored by personnel with the necessary expertise to judge whether these particular assessed needs are being met. In most instances this will mean that health care staff will need to be involved in the monitoring process.
150. Each local authority should also set up financial monitoring arrangements for audit purposes, to fulfil its responsibility to ensure that public funds are spent on the intended support. CIPFA have produced guidance for local authorities on this point and local authorities should ensure that up to date advice is being used 47. However it is important that monitoring is proportionate and focused on outcomes, with as light a touch as possible.
151. For packages to work, it is essential that these two forms of monitoring are co-ordinated. The financial monitoring should be carried out by a finance officer and monitoring of the services by the care manager. It is essential that that monitoring information is exchanged internally and that all those involved understand the purpose of self-directed support, and the role that the local authority's monitoring plays in the successful operation of the policy. In particular, information from both forms of monitoring should be considered in any decision to change the level of, or stop, self-directed support.
152. Honest mistakes should not be penalised. A message of continuity and security is crucial, because the payments often provide the support an individual cannot live without. For example, stop payment warnings should not be automatically issued when an administrative matter goes wrong.
153. As well as monitoring how well self-directed support is meeting the needs of individuals, local authorities will wish to monitor how local self-directed support schemes are working overall. As part of this, authorities should actively seek the comments and suggestions of people who receive self-directed support or who have considered doing so.
Reviews and reassessments
154. It is essential that local authorities carry out regular reviews of the arrangements. The first review date should be set when self-directed support begins. People should be made aware that they can request a review sooner if their circumstances change. The purpose of the review is to establish whether the objectives set in the original plan are being met. The local authority will also wish to be satisfied that the individual is protected from harm and exploitation.
155. The local authority will wish to speak to the individual on their own during the review. If the individual needs support the local authority should ensure that the person is given the option of having support from an independent supporter or advocate. Local authorities may also wish to speak to family members and informal carers to satisfy themselves that the person is not experiencing any difficulties with arrangements. Where an attorney, guardian or parent is consenting to the self-directed support the local authority will also wish to discuss arrangements with them.