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Direct Payments

Be in Control of your Care

Most social care services and local authorities are encouraging more and more people to opt and apply for direct payments, giving you control of your care. You have control of who you employ to provide you with the personal care and how you want that care delivered.  If you are not happy with the care provider you can easily change and replace with another provider.

Less red tape and delays in your care provision

What are Direct Payments?

Direct payments are local Health and Social Care (HSC) Trust payments for people who have been assessed as needing help from social services, and who would like to arrange and pay for their own care and support services instead of receiving them directly from the local trust.

You are given your own budget for a specific period. The local authority off course will monitor regularly how you are using the money.

Who can apply for Direct Payments?

Direct payments are normally available if you: if you have been assessed as needing services under health and personal social services legislation, have a disability and are aged 16 or over (including disabled parents) are a carer aged 16 or over, including people with parental responsibility for a child with disabilities.


How can I apply for Direct Payments?

If you are receive care services already, ask your local council or care services about direct payments.

If you are apply for care services for the first time, you will need to contact your local social care services or social worker who should discuss the direct payments option with you when they assess your care needs.

You can apply directly via Gov.uk 

If you need support to apply - ask a family member to help you with the application

You can approach your local Mind services or other local charity services

You can approach your local Citizen Advise Bureau [CAB]

Your allocated key worker or care co-ordinator can also help you with the application

You can also get support and advise to manage direct payments via the Disability Rights UK or from your local authority.


Next Step…

If you’ve qualified and opted to receive direct payments, the next step is to work out which care and care providers and services you’d like to use. There are plenty of registered care providers in your local catchment area. You will need to search and contact a few for an assessment and quotation in your local catchment area.  You can choose Bethal Manna Care in Bexley Greenwich and the local area.

Make sure they are registered with the CQC , check CQC ratings and reviews.

If you can’t manage your own finances, direct payments can be paid into a trust and managed by the trustees who could be family members, friends or professionals.

If you decide to employ a carer you will you will be deemed an employer and will need to take on the responsibilities as an employer.

This means you will need to think about tax, National Minimum Wage, sickness and holiday pay, pension, and liability insurance. This may sound daunting, No need to panic, there are agencies or organizations that can help you navigate all this;

  • •Look at local firms who offer payroll services. They’ll handle tax and National Insurance contributions for a fee.
  • •Think about using a home care agency rather than employing someone yourself. They’ll deal with all the paperwork, including references and criminal checks, and invoice you directly.
  • •Speak to a Carers Direct helpline adviser on 0300 123 1053 if you would like help with finding local support.


Managing your direct payments

There are rules set out by the local authority to make sure that everyone does this in a safe and fair way.

  • You must keep receipts to show how the budget is spent and show these to social services if they ask you to.
  • You must only spend the money on care and support services that meet the specific needs agreed in your care plan.
  • If you can’t account for everything you spend, or you use the money for things not in your care plan, you could be asked to reimburse your local authority.
  • You can’t use direct payments to pay for informal care from a spouse, partner or close relative who lives with you, unless they’re registered as a carer.
  • You can’t use direct payments to pay for permanent residential accommodation, but you might be able to use them to pay for occasional short periods in residential accommodation if your council agrees that is what you need.

The rules for direct payments vary around the country. Speak to your social worker or contact your council to find out how regional variations affect you.

Top Tip **Always keep records of what you spend your direct payments on


If your circumstances change, contact your council as soon as possible so that your needs can be reassessed – you might be entitled to more money.

Alternatively, if you don’t need to spend the full amount because your condition improves temporarily, or you go into hospital, they might need to adjust and reduce your payments.

Do not delay to inform the local authority of any change in your circumstances.


I don’t want to continue with direct payments!

If you decide you don’t want to manage direct payments yourself any more, your council has a legal duty to arrange services instead.

Similarly, if the council decides you can’t manage with direct payments, they might decide to provide services directly if there isn’t anybody close to you who can take over managing the payments.


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Social Care system ‘no longer fit for purpose’

Source: www.kingsfund.org.uk

‘Budget pressures combined with rising disability among working-age adults and a growth in the number of people over 65 have left adult social care services in England at crisis point.

‘Despite the best efforts of local authorities and care providers to protect services, the social care system is no longer fit for purpose and is failing the people who use it, their families and carers. Successive governments have promised to reform social care, but failed to do so. Politicians must be honest with the public about the shortcomings of the current system and the costs of reform.

‘Reforming social care is one of the most urgent and important social policy issue facing the country and should be at the top of the agenda for the new Prime Minister. In the meantime, additional funding will need to be found to shore up struggling services.’


The King’s Fund recently published ‘Social care 360’, a review of 20 key trends in social care. That analysis found that:

  • the proportion of working-age adults approaching local authorities for support has risen by 4 per cent – over 23,000 people – since 2015/16. At the same time, England’s increasing older population is fuelling greater demand for services
  • the amount it costs councils to pay for care per week is increasing. The average per week cost of residential and nursing care for an older person now stands at £615, a real-terms increase of 6.6 per cent since 2015/16
  • the number of nursing and residential care beds available for people aged over 75 has fallen from 11.3 per 1,000 to 10.1 per 1,000 since 2012
  • there is a growing staffing crisis in social care, with around 8 per cent of jobs vacant at any one time. There are 1.6 million jobs in social care, up by 275,000 since 2009. But 390,000 staff leave their jobs each year
  • fewer people who care for family members are receiving support from their local authority, but more are getting help through the national benefits system.

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New Models of Homecare

Source: TheKingsFund:www.kingsfund.org.uk  Dec 2018

Home care (also called domiciliary care) is social care provided in people's own homes, and may include help with washing, dressing and preparing meals. Service users include people with disabilities and older people. Care may be delivered for a short period of time following a stay in hospital (eg, reablement) or long term, for ongoing support needs. Like all social care, home care is means-tested, which means that some individuals will be eligible for care paid for by the local authority and some individuals will pay for care themselves, with others using a combination of the two.

Individuals who are eligible for local authority-funded care may choose to receive a direct payment or personal budget, which they can spend as they wish, or have the local authority arrange care on their behalf.

Eligibility for local authority funded care is also dependent on a needs assessment, and tightening eligibility has meant that home care is increasingly restricted to those with more complex needs (Age UK 2013).

In 2015, more than 350,000 older people in England were estimated to use home care services, 257,000 of whom had their care paid for by the local authority. A further 76,300 younger people with learning disabilities, physical disabilities or mental health problems were also estimated to be using publicly funded home care in 2015 (Wittenberg and Hu 2015).

Most home care, including that paid for by the local authority, is provided by the independent sector, and home care providers who deliver personal care (such as help with washing) are regulated by the Care Quality Commission (CQC). Outside of this, many people will rely on family or friends for some or all of this support.

Local authority-funded home care is usually commissioned via a competitive tendering exercise for the tasks which need to be completed and the time that will be required to complete them.

Providers are paid on a New models of home care The King’s Fund 2018 5 rate-per-hour basis. This is commonly referred to as 'time-and-task' commissioning. As well as their duties to meet the assessed needs of individuals who require care, under the Care Act 2014, local authorities also have a duty to ensure that there are sufficient services, of a sufficiently high quality, to meet need for home care. As the single largest purchaser of home care, local authorities have significant influence on markets and there is wide variation between them, exemplified in wide variation in the rates paid for care.

There have been several research reports looking at what people want from care delivered in their home and exploring what good-quality care looks like, with strong common themes (Healthwatch 2017; Maybin et al 2016; CQC 2013; ADASS et al 2017.2017); SCIE 2014; NICE 2016).


These include the following:

  • Person-centred care – caring for all the person’s needs together in a holistic, integrated way.
  • Valuing and involving people, as well as their carers and family members – ensuring that people are able to express their preferences, views and feelings. This may include ensuring that people have choices and that their views about how to make improvements are sought, listened to and acted on.
  • Continuity of care – ensuring that care is consistent and reliable. This may include ensuring that people have a properly reviewed care plan, that care workers are known to the person and limited to a small number of people visiting, providing reliable and flexible visit times, planning for missed or late visits, and ensuring that people are able to contact services between appointments.
  • Personal manner of staff – a caring and compassionate approach to care. This may include effective communication, getting to know the person and building relationships to ensure that care happens the way the person likes it.
  • Development and skills of staff – ensuring that staff are equipped with the training, supervision and experience to do their jobs effectively. This may include regular meetings for staff, personal development and training on particular conditions such as dementia
  • Good information about services and choices – ensuring that people know where to get advice and understand their choices about local care options, including quality and financial advice.
  • Focus on wellbeing, prevention, promoting independence and connection to communities – to be able to stay in their own homes and be supported to do things themselves. This may include linking people to be able to contribute to their local communities and social groups.

Challenges faced by the home care market have been outlined elsewhere (Age UK 2017; Humphries et al 2016; CQC 2013) and represent a somewhat different picture to the principles outlined above. The fragility of the home care market has been raised as a concern by the CQC, which has highlighted large churn among providers registering and deregistering (CQC 2017). Concerns have been raised about quality and there have been increase in the number of complaints and a fall in satisfaction (Local Government and Social Care Ombudsman 2016; Humphries et al 2016; NHS Digital 2016).

Home care providers employ around 670,000 people and there are around 90,000 vacancies across social care at any one time. More than half of care workers are employed on a zero-hours contract and turnover for domiciliary care staff is at 36.8 per cent (Skills for Care 2017b).

Demand for home care is forecast to increase significantly. Older users of local authority-funded home care are predicted to rise by 82 per cent, from 257,000 in 2015 to 468,000 in 2035. Users of privately funded home care are projected to rise by 49 per cent over the same period while younger adults with learning disabilities using home care are predicted to rise by 51 per cent (Wittenberg and Hu 2015).

At a time when population projections might indicate a rise in demand for social care, the amount local authorities are spending and the number of people eligible for local authority-funded home care are falling (Phillips and Simpson 2017). Against this backdrop of varying quality of care and rising demand, some innovative models and approaches to commissioning and delivering home care are emerging. This report explores those new approaches and considers their potential to provide care that is more closely aligned with what people want. New models of home care The King’s Fund 2018 7 Purpose and approach This report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:

  1. 1. Technology and digital 2. Co-ordinated care planning 3. Recruitment and retention 4. Autonomous team working 5. Alternative approaches to commissioning 6. Personalisation 7. Integrated care approaches 8. Community assets and connections 9. Family-based support and communal living

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A real alternative!

Receiving 24 hour care in your own home is now a very popular alternative to residential /care homes for individuals with long-term health needs. Thousands of families are now choosing live-in home care

Receiving care at home makes it possible to get the professional support you require without leaving the comfort of your own home with minimal disruption of your or your family routine.

  • Specialist care will be provided to you within the comfort of your home from carers who have a true understanding of your unique needs.
  • A more economical option compared to care homes - especially for couples who are able to stay together
  • You will avoid the disruption and upheaval of moving out of your home to receive 24 hour care in a residential home.
  • It is proven to improve both health and well-being
  • You can continue living life surrounded by your communities and home comforts - including pets, neighbours and social amenities
  • Your plan of care is uniquely developed to suit your needs on your own terms instead of without any rigid timetables or set routines
  • It also does provide families respite care if they need to travel or ‘just take time’ to rest without worrying about their loved ones care or safety. Bethal Manna will take away the stress.

Looking for care services can be daunting for anyone. 

Choose Bethal Manna Care for Live in Care. We will work with you to put a unique package of support in place for you – we will match you with the right carefully selected carers who are well experienced , professional , dedicated and above all caring - so you can stay in the home you love.

We know that independence, choice and dignity are important for both happiness and health.

Let us put your mind at ease. We’re here to help, our care services enable you to continue to live your life the way you wish to in the comfort of your own home and familiar surroundings.

Whether you are looking for long term or short term or on respite care basis our carers are highly trained and experienced in caring for a range conditions;

  • Dementia
  • Alzheimer's
  • Parkinson's disease.
  • Strokes
  • Multiple Sclerosis
  • Cancer
  • Palliative/ Terminal Conditions
  • Mobility and Frailty


Whether you require:

  • Companionship care, where your team of carers will support you to comfortably and safely carry out your daily activities.
  • Assistance with personal care helping you maintains quality in all aspects of life.
  • Or Complex care ensuring every individual regardless of age or disability maintains an independent and comfortable life within their home.

Contact us today to discuss your 24hrs care needs and  options.

Let us take the hassle out of care planning for you or your loved ones. Our team of professional carers are trained to provide you with the highest quality of compassionate and holistic service.