Community Services – Direct Payments
Last Updated: 17 July 2023
Where are we now
Direct payments are payments from the local council for individuals who have been assessed as needing help, and who would like to arrange and pay for their own care and support services. Direct payments in Sutton are subject to the same financial assessment by the council as for community care services and the recipient is responsible for accounting for how the money is spent.
The purpose of direct payments is to increase choice and independence for individuals by giving more control over support arrangements. Unlike services arranged by Sutton council, with a direct payment, the user is responsible for ensuring the quality of the services received. Direct payments can be used to employ personal assistants or purchase support that the local authority is satisfied will meet that person’s assessed needs. They cannot be used to purchase permanent residential care or services provided directly by Sutton. Individuals receiving direct payments can choose to mix the services they buy and can opt to increase or decrease use/frequency of services in line with how they decide best meets their needs. Individuals can also choose to cease using direct payments at any time. There is no maximum or minimum level to a direct payment.
Who can receive direct payments?
- Older and disabled people aged 16 and over who are assessed as needing services. All impairments are included (physical, sensory, learning, HIV and AIDS, emotional) but people subject to certain mental health aftercare or criminal justice legislation may not be able to receive direct payments
- A person with parental responsibility for a disabled child
- Carers aged 16 and over who are caring for a disabled adult
- People who are willing and able to manage direct payments, alone or with assistance
Direct payments within Sutton are managed by Encompass, Sutton’s Local Authority Trading Company. More information about direct payments can be found on Encompass’ website.
The rate for Direct Payment to purchase a Personal Assistant or home care service is £16 and £19 respectively. In March 2023 a total of 671 direct payments were made per week to 439 individuals at a cost of approximately £132,980. The smallest payment is £3 a week and the largest payment is £1480.50 per week, with an average payment amount of £198.18 per week.
Our Direct Payment Market
As of March 2023, a total of 439 individuals are in receipt of one or more direct payments per week.
Diagram 1: Age of Service Users in Receipt of Direct Payments
Source: Adults Social Care Sutton (March 2023)
The diagram above shows the age breakdown of individuals in receipt of direct payments. There are 108 individuals (24.6%) aged 18-25, 163 (37.1%) aged 26-49, 71 individuals (16.2%) aged 50-64, 26 (5.9%) aged 65-74, 38 (8.7%) aged 75-84, and 33 (6.6%) aged 85+.
Diagram 2: Service User Gender
Source: Adult Social Care Sutton (March 2023)
Of the 439 individuals receiving direct payments, 52.5% identified as male and 47.4% identified as female.
Whilst there are more males in receipt of direct payments than females overall, the cohort aged 50 and over are predominantly female. The graph below shows the gender/age breakdown.
Diagram 3: Age and Gender Breakdown
Source: Adult Social Care Sutton (March 2023)
The bar graph above shows that for the 0-50s 66.42% are male (41% of the total group) and 33.58% are female (20.73% of total) whilst in the over 50s this is reversed with 30.36% male (11.62% of total) and 69.64% females (26.65% of total).
As part of the adult social care assessment process, individuals who are identified as having an eligible need for ongoing care and support have their ‘primary support reason’ identified and recorded. Individuals may have a number of identified needs, however a primary reason for support will always be identified. The pie chart below shows the breakdown of primary support reasons for adults in receipt of direct payments.
Diagram 4: Primary Support Reasons
Source: Adult Social Care Sutton (March 2023)
Learning disability is recorded as the primary support reason for 218 adults (representing nearly half of the total group). A further 156 individuals (35.5%) have physical support recorded as their primary support reason and 42 (9.6%) have mental health recorded as their primary support reason. Of the remaining 23 individuals, recorded primary support reasons include sensory support, memory & cognition, social support and substance misuse.
The graph below shows the gender breakdown for the top three primary support reasons.
Diagram 5: Primary Support Reason and Gender Breakdown
Source: Adult Social Care Sutton (March 2023)
For those with their primary support reason recorded as learning disability 68.81% are male and 31.19% are female, for physical support 35.23% are male and 64.74% are female, and for mental health, 40.48% are male and 59.52% are female.
How are direct payments being spent?
Direct payments can be spent on a variety of support services that meet individuals’ assessed needs including personal assistants, day centres, domiciliary care, transport, respite, supported living, and employment support. A Direct payment cannot be used to purchase permanent residential care or services provided directly by Sutton council.
At inception a support plan reflects the support need that has been identified during the initial assessment and the direct payment funding is calculated in line with costing of particular service types that are deemed suitable to meet those identified needs. Due to the flexibility and choice inherent in direct payments, the practical use or service types may differ from those outlined in the support plan. This is, as the Care Act intended, providing the choice of service the direct payment user arranges to meet the outcomes attached to their support plan.
The data below is drawn from support plans which do not always accurately reflect the most up-to-date reality of the service type that has been purchased.
Diagram 6: Type of Service Purchased
Source: Adult Social Care Sutton (March 2023)
The graph above shows that over a third of direct payments (34.9%) are used to employ personal assistants. Almost a quarter (24.1%) are used to pay for day centre services, 17.7% of direct payments are used to fund domiciliary care services, 8.8% are used for transport and 7.6% are used for respite services.
The total weekly spend on direct payments is approximately £132,980. The graphs below provide further detail on the breakdown of this spend.
Diagram 7: Costs per Week
Source: Adult Social Care Sutton (March 2023)
Spend on employing personal assistants accounts for just over a third of all direct payment spend at approximately £44,530 per week. Domiciliary care accounts for just over a quarter of the total spend, with approximately £29,120 spent on single carers and £6,490 on double carers. Spend is approximately £29,800 on day opportunities, £9000 on supported living, £5900 on respite, £5000 on transport, and £3000 on other services. Just one client receives a direct payment for employment support at a cost of £4.81 per week.
How are direct payments paid?
Direct payments are paid to individuals using a 4-weekly payment cycle via three different methods.
Diagram 8: Payment Types
Source: Adults Social Care Sutton (March 2023)
The chart above shows that the majority of payments (67.4%) are made via prepaid card, with 20% via managed virtual accounts, and 12.7% self managed.
Sutton’s preferred method of delivery for direct payments is via prepaid cards. Most direct payment users opt to use prepaid cards as this reduces the burden of returning monitoring documents during the reconciliation period as these documents are available to Sutton via the prepaid card system in use. Those clients that have a managed virtual account are using a direct payment via prepaid card but are also paying Encompass to both hold and manage the funding on their behalf. Self-managed direct payment users represent the smallest cohort, who prefer to manage their direct payment funds through their own single use bank account.
Where we want to be
Sutton’s ambition is for direct payments to be a key care and support solution for individuals and their families, and one which optimises user choice and control. Support will be individualised and seek to enable individuals to achieve their desired outcomes. We also hope to see direct payments as providing, where an individual so wishes, equal access to commissioned services with rates that support this.
Challenges and Market Influencers
A key challenge is to support the further development of the market where accessible and good quality services meet the needs and outcomes of individuals, delivering person centred solutions.
How we need the market to develop for the future
Following co-production activity in the Learning Disability Strategy, Sutton is working to support the viability and accessibility of Personal Assistants as one of the options through which care and support requirements can be met. To support this ambition, Sutton has commissioned a Personal Assistant Support Service to work with us to develop this market. The service aims to promote the role of Personal Assistants in Sutton, improve recruitment and matching, and ensure that Personal Assistants have improved support and are able to access training and development opportunities.