News story legal challenge

21st April 2020 • Emma Cooper

The Department of Health and Social Care has published guidance for people receiving direct payments during the coronavirus pandemic.

The guidance is aimed at people who receive support via direct payments through personal budgets and personal health budgets, and local authorities, clinical commissioning groups (CCGs) and providers who support and deliver care via direct payments.

The advice takes into account the latest advice on self-isolation for households with possible COVID-19 infection, set out in guidance issued by Public Health England (PHE).

It also takes account of the latest guidance from PHE on the use of personal protective equipment (PPE) about safe ways of working for all health and care workers, including personal assistants, and the recommended PPE for community settings, including care in people’s own homes.

For people who are unable to leave the house due to self-isolation or shielding, the care and support they receive from their PA will be invaluable. It is important to understand the options available and ensure plans are made in the event of a PA being unable to carry out their usual caring role.

People who employ a PA should:

  • Urgently review the support arrangements currently in place for when their personal assistant is unable to work due to sickness or annual leave. Consider if these arrangements are robust enough should there be a need to cover for any period where a personal assistant may need to self-isolate because they are ill themselves, are in a vulnerable group or live in a household where someone has developed symptoms of COVID-19.
  • Consider alternative options, should the above plans not be robust enough to provide essential ongoing care and support. Where there are links with wider personal assistant employers, agreements of mutual support arrangements could be considered. If you receive other sources of paid support (other than your personal assistant) via direct payment, could these be flexed and increased to cover any reduced personal assistant support and vice-versa?
  • Consider alternative or additional personal assistants and/or care providers such as agencies who may be able to offer care and support or a back-up option should there be issues in continuation of your personal assistant support.
  • Ensure that details about how you like your care and support to be delivered are up to date with key information that can be shared with care staff who may not be familiar to you, including what you deem to be essential. Where possible, if there are any regular or reoccurring needs that are time- and day-specific (for example treatment sessions, attending work) please note these. Ensure that other details, such as critical telephone numbers, are up to date and available to all care staff who support you.
  • Should you find yourself in a position where your personal assistant is unable to support you due to self-isolation or contraction of COVID-19 and you have no alternative arrangements available to you, you should contact the adult social care team or CCG team that provides your direct payment for alternative care arrangements. These teams must have systems and processes in place to respond to you as quickly as possible, acknowledging the nature of your needs and circumstance, and should support you to make suitable alternative arrangements.

The new guidance also sets out the steps people can expect local authorities and CCGs to be taking to support people who use direct payments which include:

  • Ensuring that their list of individuals in receipt of direct payments is up to date and includes records of the levels of informal support available to individuals.
  • Mapping all care and support plans funded by direct payments by the local authority and CCG, to inform planning during an outbreak. Supporting providers similarly to map those packages that are self-funded.
  • Contacting all individuals using direct payments to provide information and advice for maintaining the care and support they receive and how to make contact should they think that there may be a difficulty in continuing to receive care and support via the direct payment.
  • Considering the need to draw on local community services and primary care providers to support people who use direct payments and draw up a plan for how and when this will be triggered.
  • Considering how voluntary groups can support those who use direct payments and enable links between the person and voluntary sector.
  • Taking stock of how to maintain viable personal assistant supports or alternative provision via care providers during the outbreak of COVID-19, including financial resilience. The Local Government Association, the Association of Directors of Adult Social Services and the Care Provider Alliance have published best practice advice on resilience.
  • Considering the use of assistive technology at home (for example, technology to monitor seizures and breathing problems) to provide an additional layer of support, while helping to reduce pressure on staff delivering care.
  • Developing and maintaining high-risk registers, monitoring these for early signs of package or paid carer breakdown. Where possible, contingency plans should be developed for individuals on the high-risk register.

The guidance published today is also accompanied by a Q&A, mostly aimed at direct payment holders, that directly responds to questions and concerns previously raised by direct payment holders, personal assistants, and charities and organisations that support them.

The Q&A has been contributed to by multiple departments, organisations and charities, including Think Local Act Personal, In-Control, Skills for Care, and NHS England and NHS Improvement, including the Personalised Care Strategic Coproduction Group.