Indirect payments: direct payments for people who lack capacity

Introduction

This project explored how direct payments (DPs) are operating for people who lack capacity to consent and are living with learning disabilities or dementia.

Key findings included: People had chosen indirect payments for several reasons. Where someone lacked capacity to consent, a suitable person had often chosen an indirect payment because of the desire to avoid inadequate alternative services, and/or to ensure meaningful activity for the disabled person; there was some inconsistency between local authorities in the way they were putting the 2009 Guidance into practice. Some evidence suggests that DPs were already being offered prior to 2009 to people who lacked capacity to consent via their families; although practitioners generally had a sound understanding of the Mental Capacity Act 2005 (MCA), there was a lack of clarity about its application. Practitioners were often unclear about defining the decision for which they were assessing capacity. Best interests decisions about an indirect payment were not being made in any systematic way. There was not always documentation of these decisions. Formal best interests processes were more likely to be followed when something had gone wrong with an indirect payment; identifying a suitable person was usually done informally, often because they were a family member and already involved in managing their relative’s services. Practitioners often found suitable people who were seen as having proven organisational skills, e.g. a relevant academic background, experience of social work, book-keeping, etc ; once the indirect payment was offered, there were differences in processes between people with learning disabilities and those living with dementia. People living with dementia were often ‘given’ a plan by the care manager, which assumed a minimum of care needs, and was not aspirational in nature. By contrast, it was more common for people with learning disabilities to have some form of person-centred planning, and for their suitable people to find out information about using direct payments through networking or peer support; there was a lack of ongoing support for suitable people, and the annual review was almost invariably simply a financial monitoring process.