For children and young people aged 0 to 25 years with Special Educational Needs and Disabilities
Choice and control is at the centre of all statutory services being able to offer personal budgets to individual children and young people, with special educational needs and disability, aged 0 to 25 years.
A Personal Budget (PB) is defined as the total amount of funding made available by the Local Authority or NHS Trust to meet the needs of a child or young person and support them in achieving their outcomes. Direct Payments (DPs) are one way of delivering some, or all, of this agreed funding in which children, young people and their families can direct their own support.
There are several pieces of legislation that relate to personal budgets and direct payments across health, social care and education (see sections 1.1 and 2.3). They place a duty on local authorities and health to provide the option for parents and young people to access personal budgets across education, health, social care and transport.
This policy sets out how Brighton and Hove City Council ('the Council') will fulfil these statutory duties for social care and education services.
The policy also explains the process for health personal budgets from NHS Sussex and how to access these.
This policy has been introduced as part of the actions agreed in the SEND Strategy.
The SEND Code of Practice 2015 defines SEND as follows:
The strategy vision was developed in 2021 and states:
‘Our children and young people with SEND and adults with a Learning Disability will achieve the very best they can so that they can lead happy, healthy and good lives’.
Read more about the SEND Strategy and its ambitions in the Brighton & Hove Special Educational Needs and Disability (SEND) Strategy 2021 to 2026.
The ambition is that all children and young people with SEND and their families are able to say:
The strategy has 6 outcomes to achieve Better outcomes, Better lives with 6 priorities to achieve this:
The personal budget policy links specifically to 5 priority areas of the strategy:
Increased choice and control of service provision for families is called ‘personalisation’. It is intended that this policy helps professionals, parents and young people understand the choices that can be made.
Personalisation places people at the heart of the assessment and discussions about how they would like their services delivered, ensuring they have as much choice and control over their support plan as possible. It enables the provision of services to be tailored for the individual child or young person.
Personal budgets are one element of a personalised approach to supporting children and young people with SEND.
This policy is in 2 sections.
Section 1 focuses on personal budgets more generally and how they are delivered in health, education, social care and for home to school transport.
Section 1 will include:
Section 2: focuses on direct payments which is just one way for a parent/carer of a child with SEND, or the young person themselves, to receive all or part of their personal budget.
Section 2 will include:
The council is aware that young people, parents and carers have a great deal of information to digest in their journey. To help, there will be an 5 point implementation plan to ensure the policy is put into practice and part of this will include:
It is important that anyone interested in receiving all or part of their support as a personal budget, receives information from the outset to enable them to understand all the responsibilities involved. Accessible information sheets will be shared with parent carers to reference, plus an online link to the information.
Parents can get information advice and support from Amaze Sussex: for families with disabled children and young people in Sussex. The information on the Amaze website can be translated into 31 languages by clicking on the 'Translate' button at the bottom left of every page. Amaze can translate pages into approximately 100 languages on request.
For social care personal budgets and direct payments:
Address: Wellington House, Wellington Street, Brighton, BN2 3AX
Phone: 01273 296 317
Email: childrens.directpayments@brighton-hove.gov.uk
Website: Special educational needs and disabilities
Website: Amaze Sussex: for families with disabled children and young people in Sussex
Website: www.possabilitypeople.org.uk
Phone: 01273 894 060
Website: Home - Independent Lives
There is a great deal of confusion about personal budgets and direct payments which stems from the way they have developed over time.
The most significant and recent legislation on personal budgets affecting children and young people with SEND (0 to 25 years old) is contained in the Children and Families Act 2014 and the statutory guidance on the Act, the SEN and Disability Code of Practice 2015. In addition, the Special Educational Needs (Personal Budgets) Regulations 2014 ('the Regulations') provide further legislative framework which local authorities are required to follow when offering Personal Budgets. The Regulations which apply to education personal budgets are different to those which apply to social or healthcare which means that the rules applying to these different budgets can be different.
The Care Act 2014 defines a personal budget as a written statement provided to a person with care and support needs (or a carer with support needs) which specifies the cost to the Local Authority of meeting the needs it is either required to meet (under its duty) or decides to meet (under its powers).
The SEND Code of Practice 2015 defines a personal budget in the following terms:
There are four ways in which a child's parent or young person can be involved in securing provision:
The council and NHS Sussex consider that most children and young people with SEND will have their support needs met by universal, targeted and specialist services available via the council local offer of services.
For a good summary of what a local offer is read the special educational needs and disability (SEND) reforms - England, information for parents.
A personal budget requirement may arise where a child or young person has needs which cannot be met by these services, see Appendix 1 case examples.
Personal budgets can be used for any element of care and support that allows a person to achieve their agreed support outcomes. The personal budget should be used to maximise the child or young person’s health, education or social care outcomes and support their wellbeing, safety and independence. If a personal budget is agreed from NHS Sussex it is referred to as a personal health budget.
NHS Sussex and the council commission services to provide for children and young people’s needs. These are called ‘block contracts’ and provide services such as speech and language therapy, mental health support or care services. An allocated personal budget cannot include funding already used to commission services. This includes a service delegated to a provider such as a school or college or where it is not possible to separate the funding allocated to the setting. Additionally, where it is suggested, a personal budget is to be delivered in a school, early years setting or college, the Headteacher or Principal must agree that the arrangement is workable. The monetary value of the service will be shown in the EHC plan.
The money must be used in a legal, reasonable and efficient manner. Personal budgets and personal health budgets may not be used for:
Parents, carers and young people do not need to have an EHC plan to get an assessment for a personal budget from social care and/or health.
For education, the child or young person must have an Education, Health and Care plan (EHCP).
Only a very small number of children and young people will meet the eligibility for continuing health care and the NHS team will be aware of these families via the health care pathways in place. If a family would like their continuing health care to be provided as a personal health budget, this can be discussed with the health professionals involved. Read more about Children and Young People’s Continuing Care.
The personal health budget policy and process for the NHS in Sussex is all age and information. The NHS also advise using the Independent Lives website for information.
A personal health budget can be taken as set out in Section 1.2, by organised arrangement (notional budget), via a third party on behalf of the child’s parent or carer or the young person, or by a direct payment.
To clarify:
Children and young people with long term mobility needs (6 months or over) can be assessed for a personal wheelchair budget. Read about the Wheelchair and Specialist Seating Service.
If a family or professional consider a package of support is needed to meet the needs of a child or young person over and above that which is provided by universal or targeted services, the family or professional can ask for an assessment. If, following assessment, need is identified that cannot be met by universal or targeted short break services already provided by the local authority, see get social care support with special educational needs and disabilities. It may be appropriate to consider a personal budget or direct payment.
A personal social care budget will be focused on the needs of a child, young person and/or the family. This is determined by the child being a ‘child in need’ as defined in the Children Act 1989. The council wish to develop this area to link meeting need to meeting life outcomes such as gaining independence skills, being more confident when out in the community and learning how to stay safe. The short breaks strategy and developing offer also aims to enable disabled young people to have more opportunity to access activities in the community and does not require an assessment to access these services.
When a child, who has already been assessed and whose family is receiving a direct payment and their case is open to the specialist community disability service (SCDS), reaches 14 years their case becomes the responsibility of the 14 to 24 transitions pod in the SCDS social care team. The aim of this pod is to start the transition to adult services process and conversations should start with the family. The young person will have an allocated worker until they are 18 years and will have annual assessments of their needs and their direct payment package. The Transitions Tracking process where all 14 to 17 year olds are discussed regularly, includes all aspects of their needs and care, health, education, accommodation, finances etc. The meeting includes partners from other agencies, including adult services, to ensure that the young person is known to them prior to them reaching 18 years and so that plans can be made well in advance.
At 17 years all young people supported by the transitions pod, will have a Care Act assessment which will assess their needs as an adult, including their personal budget and any direct payments package. The social worker will assess their needs and if the direct payment will continue at the same rate, or if they need more or less funding and what that will be used for.
As young people transition to adult services, they may wish to consider if they would like to oversee their personal budget options. A mental capacity assessment may be required to determine if this is possible.
The young person’s case will be presented at the 18+ panel with their proposed new package of support which might include a direct payment (and will flag any other need such as accommodation or respite) and the package will be agreed or not. If a direct payment is agreed, the social worker will amend this on the social care system and the adults’ direct payments team will process.
If a young person has not had a service as a child, but is likely to need one as an adult, they, or any professional working with them, can request a Care Act assessment via Front Door for Families. They will then be allocated to the correct social care team. For young people 18 years and over the young person or any professional working with them can request an assessment via the Care and Support for adults hub.
The Care Act 2014 mandates, a personal budget as part of the care and support plan for people over 18 years with eligible care and support needs, or where the local authority decides to meet needs. It also clarifies a person’s right to request a direct payment to meet some or all of their care and support needs, and covers people with and without capacity to request a direct payment.
A young person or their parent or carer have a right to request a personal budget when the local authority has completed an EHC needs assessment and confirmed that it will prepare an EHC Plan. They may also request a personal budget during a statutory review of an existing EHC Plan:
If a child or young person is eligible for home to school or college travel assistance under the council’s home to school transport policy or post 16 transport policy, then it may be possible for travel assistance to be taken as a personal budget. Find out how to apply for help with home to school transport.
All applications for assistance are assessed on a case-by-case basis by the Council’s transport panel. Most personal travel budgets are paid as direct payments and would be for mileage or taxi travel to the nearest suitable school.
If a child or young person has an EHC Plan, the personal budget should reflect the holistic nature of an EHC Plan and can include funding for special educational, health and social care provision. Any personal budget should be focused to secure the provision agreed in the EHC Plan and should be designed to meet the outcomes set out in the EHC Plan. A child or young person could have a combination of personal budgets from social care, health, education and travel assistance and these budgets can be used flexibly, with the agreement of service leads, to provide a holistic package of support.
It is important to understand that not everything identified in an EHC Plan is available as a personal budget. Options for personal budgets are determined by the assessed needs of the child or young person and influenced by what is already available through the local offer of services, eligibility criteria for different components, local circumstances, commissioning arrangements and other individual factors such as school preference. The local authority will always consider the availability of local services prior to commissioning any alternative provider.
The ‘local offer’ special educational needs and disability (SEND) reforms - Information for parents sets out what is available from education, health, and social care to children and young people with special educational needs and disabilities, including those who do not have EHC Plans. Find out more about Special educational needs and disabilities.
Options for personal budgets relate to more specialist or individualised provision for a child or young person.
For a personal budget from social care services an assessment of need is required. In order to request an assessment for a child or young person, a referral should be made to Front Door For Families. The child or young person will be allocated to a social work resource officer who will complete an assessment in 45 working days. For adults over 18 years of age a referral needs to be made to Adult Social Care services so that a Care Act assessment can be completed. Once an assessment has been completed and need is identified, each case will be considered at a multi-agency panel for a decision. An amount of funds can be allocated which is the indicative personal budget. This can be taken all or part, as a direct payment, see Section 2.
There is an application form, available on request from the Special Educational Needs Statutory Service, to assist with providing all the information required for the local authority to make a decision. The process for requesting a personal budget should be a collaborative one involving children, young people, and parents in decision making. The opportunity to consider options, and make a request for a personal budget, is part of the EHC needs assessment process. When the draft EHC Plan/draft amended EHC plan is developed and outcomes agreed, the child’s parents and the young person can indicate if they would like to request a personal budget for any of the available elements of the provision in the EHC Plan and how they can do this. Further help and assistance to complete the application is available from Amaze SENDIASS.
If a personal budget is agreed, this is then included in the draft EHC Plan ready for the consultation phase with the family and the appropriate educational institutions, and final approval by the decision-making panel. If a school is to be involved in delivering a personal budget, the Headteacher and Governing Body will need to agree to this.
A similar process is followed for EHC Plan annual reviews. If, as part of the annual review process, a parent/carer makes a request for a personal budget for any of the available elements of the provision in the EHC Plan, this must be considered. The same application and decision-making process applies. If a school is to be involved in delivering a personal budget, the Headteacher and Governing Body will need to agree to this.
If it is agreed that a Direct Payment is to be made, a formal agreement is set up between the family and the council. This includes monitoring and review arrangements to ensure the direct payment is used to buy the service which the child/young person has been assessed as needing as part of the EHC Plan. It is important to read section 2 of this policy which specifically deals with direct payment arrangements.
In Brighton and Hove, there will be further information for young people and families setting out the possible routes to a personal budget, how these are applied for and what sort of things they can be requested for. See Appendix 2 for a flowchart of the process.
If a child or young person qualifies for home to school travel assistance then the application process for a personal travel budget is set out in policy. Find out how to apply for help with home to school transport.
The personal budget is tailored to meet high levels of need where the council agree a family can arrange their own travel provision for their child’s needs.
The resource panel will only agree a personal travel assistance budget where it is cost effective to do so. This can be taken as a direct payment, see section 2.
For children and young people who are eligible for a personal travel assistance budget (PTB) to assist them to attend an educational establishment, a daily amount will be allocated after journey prices to and from home have been estimated (either for mileage or taxi provision). The young person or parent/carer of an eligible child is then able to arrange their own transport. The direct payments will be made three times a year at the end of each school term or pro rata depending on the time the application is agreed.
If a personal budget for home to school transport is agreed and this is taken as a direct payment, then parents/carers will become responsible for the commissioning of that service and any staff who transport their child.
Co-production should be at the centre of the approach to supporting children and young people with additional needs or SEND and their families to access a personal budget if needed. The social care and SEN Statutory Service will work with all partners, families, young people, parent carer forums and local providers to achieve this.
Personal budgets should create opportunities to:
You can get advice and support with understanding personal budgets and the application process from Amaze SENDIASS the local SEND information, advice and support service.
Appendix 3 sets out a number of frequently asked questions which can be updated as the policy is reviewed.
It should be clear how a decision about a personal budget has been made by the LA. If a request is refused the explanation should be understood by everyone in the process. There is a review and appeals process explained in sections 1.12 to 1.14.
Each decision is made on its own individual merits and budgets may be agreed to meet outcomes for a set period. The NHS and council services have their own decision making system for allocating resources.
Decisions on whether to allocate personal budgets will be based on:
There are different options for managing a personal budget including a Direct Payment. These are set out above in section 1.2. For clarity these options are further explained below.
There are four ways in which a child's parent or young person (over the age of 16 with capacity to make decisions) can be involved in securing provision:
Where the child's parent or the young person receive the funding to contract, purchase and manage the services themselves, see Section 2 for details. The direct payment is paid into a separate supported bank account belonging to the parent/carer or young person or uploaded to a prepaid card. The parent/carer or young person then organises the services themselves and arranges payment to meet their needs and outcomes. Spend and accountability is monitored by the council.
Where the local authority, school or college holds the funds and commissions the support specified in the plan. These are sometimes called ‘notional’ budgets and can also be used where contractual, or funding arrangements mean that cash cannot be released as a direct payment or where economies of scale are present.
Where direct payments are paid to and managed by an individual or organisation on behalf of the child's parent or young person. This is usually the case for social care direct payments where Possability People are commissioned by the council to provide HR services for families. This is independent of the council and a small fee is charged to help manage the personal budget. This fee will be included within the personal budget/direct payment allocation, see page 5 for contact details.
Where the parent/carer or young person take some of the personal budget as a direct payment to organise and pay for some services themselves and ask the council to continue to manage the rest of the services and payments. This can work well if there are only a couple of areas where the young person or parent/carer would like to directly manage organisation and payment for support.
If a parent/carer has requested their personal budget allocation to be delivered as a direct payment and this has been agreed, section 2 of this policy will then govern the allocation, monitoring and review of that funding.
There will be regular reviews of direct payments/personal budgets through council set meetings and the statutory annual review process.
The council will not agree personal budgets that will result in the duplication of services that are already in place.
Examples of personal budget arrangements and direct payments are set out in Appendix 1.
An important question to consider is how a personal budget fits with other sources of support, access and opportunity in the community, at school, college or in training. Personal budgets, and how they might be used, are only one part of a much wider system of opportunities, support, and activities available to children and young people who need additional individual resources to enable them to make good progress.
The council is not currently able to offer a direct payment for services which are fully commissioned from in house providers.
A personal budget may be considered where a young person is recorded as in ‘Education Other Than at/in School’ (EOTAS). However, if at all possible, services will be provided by those commissioned by the local authority.
High needs ‘top-up’ funding (Element 3) currently goes to schools and colleges to provide the support required by the child/young person to meet their identified outcomes. The scope of a personal budget for special educational needs will vary depending on a young person’s or child/parent’s preference for school or educational institution. For example, as part of their core provision, special schools, and colleges make some specialist provision available that is not normally available in mainstream schools and colleges. The choice of a special school with integrated specialist provision may reduce the scope for a personal budget.
NHS Sussex uses a ‘resource allocation tool’ based on the child or young person’s assessed health needs and outcomes, to determine the level of personal health budget awarded. The amount of budget is based on the identified and assessed health needs. If a direct payment is agreed, typically this would be the employment of trained carers to support the child in school or at home. Find out more in the Personal Health Budgets, Sussex Health & Care.
All funding requests and arrangements will be considered and agreed by a multi-agency resource panel and recorded in council systems. All funding is assessed on an individual basis dependent on the needs of the family.
The resource panel must be satisfied that the support plan will meet the child/young person’s assessed needs before it will confirm the final amount of the personal budget. This information will be recorded within the child’s care plan, and this will be reviewed annually or sooner if there is a change of circumstances. The support plan will provide the evidence to establish the final cost. These are specialist ‘Short breaks’ packages of support for children and young people, agreed as part of a support plan or adult care plan and must be reflected in their EHC Plan. Find short breaks for children with special educational needs and disabilities. If a personal budget is agreed, some or all of that can be used as a direct payment, see Section 2.
See section 1.6.3.
All personal budgets and direct payments are subject to review and will either be a part of EHC Plan annual review process, transport review or social care annual review processes. If an early review is called for any reason, the personal budget will be reviewed as part of that.
Any review is held in consultation with parents, young people and schools. The council or NHS Sussex has discretion to decide whether it will continue to provide a personal budget or personal health budget for a child/young person.
The review will address whether the agreed outcomes for the personal budget or personal health budget are being met and that any stipulations or requirements made by the council or NHS Sussex have been followed.
Reviews will also note changes in needs and circumstances. The amount of money allocated to a personal budget or personal health budget may change as the result of a review.
When a young person reaches the age of 16 they will be at the centre of creating their own support plan if able to do so. You can get advice from Amaze.
The council and NHS Sussex have a responsibility to ensure that the personal budgets/personal health budgets they agree represent value for money through robust care planning and monitoring.
The council and NHS Sussex also have a responsibility to ensure that public money is spent and accounted for appropriately. Personal budgets/health budgets will be audited (targeted and random) to provide assurance that children and young people are achieving the best possible outcomes within the available resources, and that funds are being used for the purpose intended.
Audits (particularly for direct payments, see Section 2) will require access to records of payments and contracts including invoices and bank statements among other things. These checks will provide assurance both to the council and NHS Sussex that the funds are being used effectively in accordance with approved support plans and as set out in the funding agreement. The use of funds for any items not agreed with the council or NHS Sussex could be a breach of this policy and guidance.
For travel assistance direct payments, receipts and attendance records must be submitted at the end of each term, so that payments for the following term can be calculated. Any days where the student has not been able to attend their course will be deducted from the next payment.
Personal budgets are not a welfare benefit and do not represent an entitlement to a fixed amount of money. Money that has not been used and has accumulated may be recovered by the council or NHS Sussex, see section 2.7.10 for further information.
For social care and health personal budgets, it is available for families to use a third party organisation to manage their direct payments and ensure that the money is used to support the child and pay any necessary expenses for carers, like national insurance. This service is available on an individual basis and will be discussed during the assessment, see Section 2.
Complaints about the process of setting up, administering and monitoring the personal budgets and health budgets will be managed under the council and the NHS Sussex complaint procedures.
If following assessment, it is decided that an individual is not eligible for a personal budget or health budget, the individual, parent or carer of the child will be sent a letter detailing the reasons why. The letter will give the details of how to ask for a review/appeal the decision and the timescale in which the appeal should be received.
The following issues can be dealt with through the Appeals Process:
If the individual, or parent/carer of the child need help to ask for a review or to make an appeal they should contact Amaze SENDIASS in the first instance.
For personal budgets provided by social care the individual, parent or carer of the child will need to contact the person working with them in relation to the assessment and support to explain they would like to ask for a review or appeal against a decision and provide the details. The appeal can be made in writing, by phone or by email.
The appeal will be considered, in the first instance, by the Head of Service and the individual notified in writing within 10 working days of the date of their appeal against a decision. Find out more about Children's services complaints.
For personal health budgets provided by NHS Sussex the appeal will be reviewed in the first instance by the Head of Service with a further right of appeal to the NHS Sussex exceptional funding panel. Find out more about Comments and complaints - Sussex Health & Care.
For personal budgets provided for Education, Health and Care Plans any dispute relating to the request for a personal budget or its contents, should be pursued by way of a request for a review in the first instance to the Head of Service and this will be reviewed by a panel.
Any representations made by the parent/young person must be considered as part of the review. Following the review, the decision, with reasons, must be given in writing.
If the Council refuses to identify a personal budget, individuals cannot appeal to the Special Educational Needs and Disability Tribunal against that decision. This does not affect the right to appeal to the Tribunal if the disagreement relates to other sections of the child/young person’s EHC Plan.
If individuals are not satisfied with the outcome of their appeal or complaint, they can contact one of two Local Government Ombudsman services to look into the matter. The Local Government Ombudsman is responsible for complaints about councils and the service they provide.
The Parliamentary and Health Service Ombudsman is responsible for complaints about NHS services. Both offer independent, impartial and free services that deal with complaints about public bodies. The Appeals Process does not affect an individual’s rights to contact an Ombudsman at any time. However, they will only usually investigate a complaint after the local authority or NHS Trust has been given the opportunity to consider it first.
Find out how to complain to the Local Government Ombudsman.
Find out how to complain to the Parliamentary and Health Service Ombudsman.
This part of the policy focuses on the provision of Direct Payments as part of the overall Personal Budgets policy to children and young people with disabilities up to the age of 25, and their families.
Direct Payments are payments that are paid to either a young person, aged 16 years and above, or to the parent or carer of a child or young person with SEND up to the age of 25, or to a nominated third party. The payments are made in lieu of direct provision of some or all the service. Direct payments can promote independence, choice and inclusion by enabling the purchasing of support and services by, or on behalf of, a family.
For social care services, they are made available to those children and young people who have been assessed as meeting the threshold for social care support and existing universal and/or targeted services alone, cannot meet their needs.
Personal budgets taken as direct payments can be made for, health and social care provision or SEND education, see Section 1.
This refers to the budget that will be made available, if following an assessment, a child or young person needs additional and individual support at home or when out and about in the local and wider community. Some or all of this personal budget can be taken as a direct payment to purchase personal assistant support, or a service known as ‘short breaks’. A personal social care budget may also be offered to purchase equipment (see below). A direct payment gives the service user flexibility to look beyond ‘off-the-peg’ service solutions at options that may include employment, education and leisure activities as well as personal assistance to meet their assessed needs. Many people using direct payments have experienced the benefits of increased opportunities for independence, social inclusion and enhanced self-esteem.
This can be used for Children or Young People who have complex, long term and/or life limiting conditions and meet the criteria for NHS Continuing Health Care. A personal health budget can be taken as a direct payment and may be used to fund care or to purchase equipment or other services. Personal Health Budgets in Brighton and Hove are awarded through NHS Sussex and are subject to individual assessment and review.
This is the amount of money required to meet the needs of a child or young person with an EHC Plan for some or all of the education provision set out in the plan and the outcomes to be met. Taking all or some of this as a direct payment can help give more control over what the money is spent on, see Section 1.
All Direct Payments must be made based on an assessment which has established that the child or young person has eligible need, and the parent, carer or young person has decided that they would like to receive some or all of their services as a personal budget that they wish to self-manage. This is then termed a direct payment. This will be following one or more of the assessments below:
The key factor is whether the allocation of a personal budget, as a direct payment, will help that individual achieve the outcomes as laid out in their care plan or EHC Plan. It is therefore essential that the allocated worker or case worker is clear about what the agreed outcomes are for the child or young person, and that this information is clearly recorded in the EHC Plan or care plan and communicated to parents, carers and young people. Payments must be used to pay for arrangements to meet the needs and outcomes as specified in the plan.
The council must be satisfied that the child or young adult’s welfare will be safeguarded and promoted by the means of a direct payment. This will be determined as part of the consideration of a request for a personal budget and taking some or all of that as a direct payment. The allocated worker should ensure that the making of a Direct Payment is an appropriate and safe way of meeting assessed needs as set out in the support plan.
Where a child or young person has an EHC Plan, direct payments can be made to:
Those with parental responsibility for a disabled child under 16 years old. You can receive direct payments for a disabled child if you have parental responsibility and the child has been assessed by the local authority as eligible for a service. A needs assessment will have been carried out by the local authority prior to your application for direct payments. The assessment must consider the needs of the family as a whole unit, rather than just the needs of the child.
Disabled young people aged 16 and above following a mental capacity assessment, who meet the threshold for the service and have the mental capacity to consent to receive a Direct Payment and have given that consent.
If there is a disagreement between the young person and their parent about who should manage the direct payment, the council will provide the direct payment to the young person, where it believes that the young person is able to manage the direct payments with appropriate support and the arrangement of safeguards and promotes their welfare themselves.
The person must be able to make choices and to select how the personal budget, to be paid as a Direct Payment, is used to meet the agreed outcomes.
The person must be capable of managing a Direct Payment by themselves or with such assistance as is available. Support would be considered and organised by the social care lead.
The recipient (parent or young person) is not subject to certain mental health or criminal justice legislation.
Persons who have been placed under certain conditions or requirements by the courts in relation to drug and or alcohol dependencies (Compulsory Treatment Programs or similar schemes).
Disabled children and young people who are under the age of 16.
Carers of disabled children, who do not have parental responsibility for that child, where the payment is made in respect of services for that child.
Direct payments (DPs) can be provided to an individual, or their representative, with assessed eligible needs. However, legal frameworks vary within which direct payments can be provided.
The legislative framework is contained in the following:
The council is under a duty to offer direct payments as a way of meeting any duty it must to disabled children to provide services under Section 17 of the Children Act 1989. However, it is not possible to compel someone to accept services by way of direct payments if they do not want this. If direct payments are refused, any services for which the individual is eligible must be provided by the local authority either directly or indirectly.
In making direct payments, the council is subject to the general duty to safeguard and promote the welfare of children in need (Children Act 1989) and to promote their upbringing by and within their families when making these payments in exactly the same way as when providing direct services.
In principle, any person assessed to have eligible needs, including carers, can receive a DP to arrange their own care. However, there are conditions that apply to this relating to a person’s capacity, capability and the appropriateness of providing a DP to an individual.
Due to the differences between children and adult services legislation, transition arrangements are in place as set out in Section 1.5.2.
A personal budget given as a direct payment must be used lawfully to meet the child or young person’s assessed needs and support them to achieve outcomes as agreed between the recipient and council. The young person or their parents, carers are required to sign a personal budget agreement where a direct payment is chosen. This agreement explains what the person managing the budget must do to comply with council and/or NHS Sussex requirements.
Young people and their families should read this carefully, as the council or NHS Sussex may stop making personal budget payments if there is a failure to comply with requirements. Details of who to contact with any query will be included in the letter that accompanies the agreement documentation.
These are possible options of how direct payments can be used to meet assessed needs - this list is not exhaustive:
In addition to note for all direct payments:
Should a parent, carer or young person wish to use their direct payment in ways which are not explicitly permitted or prohibited above, they should seek the opinion of the service who granted the personal budget. The service will use usual processes to consider the impact of the proposed use on the planned outcomes for the child/young person in determining whether this should be permitted, and the Service Manager may approve their response. Any decision will be made on a case-by-case basis.
For travel direct payments, the parent or carer will also be required to sign an agreement confirming that they take responsibility for getting that child or young person to and from their school or educational establishment for the full or remaining part of the academic year.
Where a direct payment is used to employ staff, the young person or their parent will be the employer. This means that they will have to fulfil all the duties of the employer, for example obtaining appropriate employer’s liability insurance.
The council and NHS Sussex do provide support with direct payments through an employment support agency. Many families find using a third party arrangement easier than directly appointing staff. For personal health budgets NHS Sussex can advise families about this. For social care direct payments the council currently use Possability People, see details on page 5.
The council and NHS Sussex do not usually allow family members living at the same address as the child or young person to be employed to support them, but this can be discussed with social care staff in exceptional circumstances. In some cases, it may be very difficult to employ the right PA and siblings or extended family members (over the age of 18 years) may be well suited to support.
Young people, parents or carers are responsible for ensuring that the direct payment funds are spent only on the assessed needs to meet identified outcomes in their child’s social care plan or EHC plan. If a parent, carer or young person is having difficulty recruiting a personal assistant, alternative options can be explored to meet identified needs if agreed with a social worker or social work resource officer.
When a personal assistant cannot be recruited and or a decision is made with a social worker or social work resource officer that alternative provision can be identified this needs to be planned so that the funds in the account appropriately cover these alternatives.
A Disclosure and Barring Service (DBS) check must always be obtained for anyone working with children or young people (this applies 0 to 25 years for children and young people with SEND), together with a complete employment history. A DBS check is a police check to confirm that the person has not committed crimes that would bar them from working with children and young people. Find out more about DBS checks for childminders and childcare workers. The council will fund these checks.
Where the person employed or the care purchased as part of a personal budget involves a delegated nursing task, there must be an appropriate scheme of training, competencies, and on-going oversight of the provision of care. NHS Sussex reserves sole discretion to agree or refuse a personal budget that involves delegated nursing tasks.
The council and NHS Sussex expect parents or carers or family members to accompany the child or young person on transport in the majority of cases. For those young people age 16 and over this may not be necessary (unless their care and support needs suggest otherwise).
When arranging transport, it is important to use licensed companies that carry out DBS checks on their drivers. Anyone is entitled to ask the taxi company they plan to use to confirm that DBS checks have been carried out on their drivers. We advise parents and carers to seek confirmation of DBS checks in writing.
If a private individual or friend of the family is asked to transport a child or young person, then it is the parent or carer’s responsibility to check that they are a suitable person to be responsible for the child or young person.
Each agency will have internal process maps but in summary:
Personal transport budgets (PTBs) are considered as part of the home to school transport application process. If a PTB is agreed, an agreement letter is sent detailing the payment schedule.
Following social care assessment and care/support planning, the parent, carer or young person will be advised about the option of receiving services via a direct payment. Requests will go to panel and decisions will be fed back to the allocated worker who will inform the parent, carer or young person.
For social care, the direct payment administration officer prepares the personal budget or direct payment agreement for the parent to sign and return before any funds can be released.
Following an EHC needs assessment or as part of the EHC Plan annual review the parent can apply for a personal budget on a form, available on request, from the SEN Statutory Service. This needs to be returned to the service to decide about the allocation of the direct payment if this has been requested. Decisions will be fed back to the allocated worker in the usual way and the parent informed. Agreements will be sent out to the recipient to be signed and returned.
Usual council process will be followed and the parent, carer or young person informed. Equipment for education, to be part of a personal budget request, can only be requested for a new EHC Plan or at EHC Plan review.
One-off arrangements should only be used where an on-going agreement is not suitable or necessary.
If the application for a one-off payment is approved, a one-off direct payment agreement letter must be sent which explains to the family in general terms the “assessed outcomes” that the one-off direct payment is intended to meet and may include any reasonable limitations to the choices that the family can make about their purchases.
The direct payment recipient agrees to purchase goods or services of the type outlined in the letter within a specified period. They also agree to send in details of their purchases (within 6 months) and the family write/email to say how they’ve spent the money for council audit purposes.
If the payment is a one-off payment to meet a temporary change of circumstances for a child where the parent is already receiving direct payments, no new agreement is required as the existing on-going direct payment agreement is still applicable.
If there is not agreement to the decision to allocate a direct payment, a letter will be sent to the parent or carer explaining how this decision was reached, and they will have the right to appeal this decision, see Section 1.12 to 1.14.
Payments will be made to the recipients depending on the individual service arrangements. For social care this is weekly, for other agencies this is usually monthly or termly. This will be clearly set out in the funding agreement.
All recipients of direct payments (except for recipients of one-off payments) are required to have a separate and suitable bank account before any payment is made or use a pre-paid card. All new recipients will be required to have a supported bank account if a pre-paid card cannot be used.
The reasons for this are:
At the current time, both dedicated bank accounts and supported bank accounts exist for the purpose of direct payments. We have agreed to move to supported bank accounts or prepaid cards for all.
Responsibilities of the parent or carer or young person:
The council can use pre-loaded payment cards for some aspects of children and young people’s direct payments and the use of pre-loaded cards may expand in the future.
Individuals opting to receive a direct payment are required to sign a direct payment agreement. Currently these vary across agencies and council departments but will be rationalised over time. Agreements exist for NHS Sussex, Social care, Travel assistance and SEND education.
Good practice requires that the allocated worker discuss the Direct Payment Agreement with parents and young people so that the potential recipient has adequate opportunity to ask any questions about the clauses.
The agreement will be signed by the allocated worker on behalf of the council and the recipient of the direct payment.
No payments should be made until a Direct Payment Agreement has been completed and signed by the council employee and the direct payment recipient. A copy of the signed agreement is kept on the child/YP’s file with a copy being sent to the direct payment recipient.
For those still using dedicated bank accounts, if parents or carers fail to send the appropriate paperwork to the direct payment’s administrator or business support manager, by the due date, they will be sent one reminder giving one whole month as a final deadline.
If the returns are not received by the deadline, future payments will be suspended with immediate effect. Payments will not be reinstated until the issue is resolved or suitable alternative arrangements are put in place. The allocated worker is copied in on all correspondence.
Where families are unable to comply with the monitoring requirements on a temporary basis, perhaps due to short term difficult circumstances, they should let the Direct Payments Administrator, or their allocated worker know, and alternatives can be explored.
All recipients of a direct payment will have an allocated worker who remains responsible for the support provided. The allocated worker is responsible for communication with the family about decisions relating to the personal budget or direct payment.
The council will keep in regular touch with the recipient over the first 6 months to ensure that the direct payment is being used for the services it was intended to provide for, and no large surplus of funds is being built up due to services or PAs not being available. This is to ensure that the council know how the family is finding the process and the recipient is confident to manage the payments and so that any further support can be offered as is necessary.
The council is aware that PA recruitment has been difficult, and steps are being taken to provide a PA register. All monitoring of unspent funds will be carried out understanding this difficulty and helping families resolve these issues and securing alternative provision when a PA cannot be recruited.
Financial monitoring will continue throughout the year.
The purpose of financial monitoring is to:
The direct payment together with the overall package of support will be reviewed at least once per year through a formal review process (such as Child in Need review, EHC Plan annual review, Pathway plan review or care act review). This is to ensure that the care needs, outcomes and conditions of the direct payment agreement are being met, and to double check that all the required set up processes have been completed.
The processes for review of direct payments and the overall package of support must be in line with the team’s practice guidance.
The direct payment agreement must be reviewed each year and an updated copy issued if necessary and placed on file.
Direct payment rates will be reviewed taking a one council approach across both adults and children’s services. It is expected that there will be annual review of direct payment rates which will be made in line with inflation and the cost of living index and that rates will also be considered in light of any legislative change, national minimum wage and living wage and national benchmarking. There is no expectation that there will be an annual increase.
A decision to discontinue a direct payment can be made by, NHS Sussex, the SEN Statutory Service, the Social Work team, the Home to School Transport Team or the direct payment recipient.
The normal notice period for termination in either direction should be at least four weeks. In coming to a decision or accepting a request to end a direct payment, the allocated worker should consider the following:
Details of this discussion and the reasons for the decision should be recorded.
Where it is necessary to discontinue a direct payment either temporarily or permanently consideration should be given to any on-going contractual responsibilities which may need to be met.
In the event of a dispute with the council regarding use of a direct payment, individuals may wish to get advice from Amaze. (see page 5) or to use the council complaints service.
Direct payment recipients must be informed, in writing, of any changes to their anticipated payments with a copy sent to the children's finance team.
In social care, the direct payments administrator is responsible for altering payments on the council system and will send a new payment schedule to the family.
If there are concerns that an individual’s support provider or employee is unsuitable for the child, stopping the direct payment can be considered in accordance with the guidelines above.
When the recipient would prefer to use an agency, the council would make the necessary arrangements and payments directly to the identified agency.
See section 1.5.2 for transition arrangements. Payments may change or cease at 18 years dependent on the outcome of the 18+ panel.
Transition planning will have taken place by the allocated worker in the transition pod in partnership with adult services. This will allow for ongoing appropriate support to be coordinated. Should the young person not meet the criteria for continued payments, the direct payment will cease, and advice and support will be offered as to what alternatives might be available.
Some children may not use or need a direct payment for a short period because of hospital admission, loss of their personal assistant or some other unforeseen eventuality. If this period is longer than four weeks, a review should be carried out and consideration given to whether there are grounds for reducing, suspending or discontinuing the payment for that period. The allocated worker must notify the children's finance team of their decision.
Councils have found that instances of fraud are rare, and fears of fraud should not deter staff from promoting Direct Payments, see section 2.7.10 for surplus funds.
It is a requirement that personal budgets and direct payments are used to meet the eligible assessed needs of the individual, in accordance with any conditions imposed in the personal budget and direct payment agreement and relevant policy and guidance.
If the council or NHS Sussex suspect that a personal budget or direct payment is being misused, the following action will be taken:
The allocated worker must advise direct payment recipients at the outset that the council might require some, or all, of the direct payment to be repaid if the council is not satisfied that the money has been used to meet the outcomes identified in the support plan or EHC Plan or the individual has breached any of the terms and conditions of the direct payment agreement.
If a decision to discontinue a direct payment is to be made, a full and frank discussion with everyone involved should take place prior to the decision being confirmed. The allocated worker should explain the rationale for the decision very clearly to all parties and record this on the case file including the date that the direct payment will be discontinued, and alternative service options offered.
Financial Regulations require all suspected financial irregularities to be reported (in writing) to the Head of Internal Audit and Counter Fraud so that an internal audit investigation of the allegations may be undertaken. In the unlikely event that fraud is confirmed (i.e. intentional misuse of public funds), this may lead to prosecution and a criminal record. Notice of withdrawal of the direct payment will be given in writing; there is no fixed notice period for stopping a personal budget.
If a young person, or parent/carer of children receiving a personal budget, managed by others, has concerns about the potential misuse of the personal budget they can request that it be audited. Repayment will not be sought from a direct payment recipient if they have been the victim of fraud, but the council retains the right to take necessary action against the perpetrator of such fraud.
A direct payment for travel assistance may be stopped if the child or young person’s attendance is not satisfactory or if the parent or carer can no longer manage to deliver the transport arrangement. The parent or carer should provide 28 days’ notice if they wish to change the agreement. Any monies paid for days the parent or carer will no longer transport the child or young person will have to be returned to the council before alternative arrangements commence.
For those receiving direct payments, the council will keep in regular touch with the recipient over the first 6 months to ensure that the direct payment is being used for the services it was intending to provide for, and no large surplus of funds is being built up due to services or PAs not being available. This is to ensure the recipient is confident to manage the payments and so that any further support can be offered as is necessary.
The council complete quarterly reconciliations on all accounts. There is an allowable excess of 8 weeks. If funds are more than 10-12 weeks in excess at the quarterly reconciliation, the council will contact the family to establish why this has happened and will seek to find agreement for how this surplus will be managed. This may include the recovery of some unused funds back to the council, if any underspend is not allocated or is not to be allocated to a child or young person’s support plan.
If the local authority becomes aware that someone is or will be unable to secure the services to meet their child’s needs through their own arrangements, either temporarily or in the longer term, then the council will need to take steps to meet its statutory responsibility which may include to provide or arrange alternative provision of services for that child.
Allocated workers should discuss the need to have contingency arrangements in place with direct payment recipients at the outset, and at reviews, to ensure that the child is more likely to receive the education care they need should the usual arrangements break down.
The council will also need to be prepared to respond in these circumstances just as it would with any other person receiving support. It may decide to step in and arrange the services where this is necessary to meet its responsibilities. If this happens a pro-rata number of payments would usually be recouped at a later stage.
Alternatively, the council could also discuss other ways of the family continuing to manage their own care by using the direct payment. For example, use of agency staff if their own personal assistant is unavailable particularly if the difficulty is temporary or unforeseen.
This policy will be reviewed every three years from the date it is ratified or sooner as required by legal or local necessity.
| Term | Meaning |
|---|---|
| SEND | Special Educational Needs and or Disabilities |
| LA | Local Authority |
| LD | Learning disability or difficulty |
| Amaze | Local parent advice and support service for children and young people with SEND |
| SEND | Special Educational Needs and or Disabilities |
| LA | Local Authority |
| LD | Learning disability or difficulty |
| Amaze | Local parent advice and support service for children and young people with SEND |
| PaCC | Parent and Carers’ Council |
| SENDIASS | Special Educational Needs and Disabilities Information Advice and Support Service |
| EHC | Education, Health and Care |
| EHCP | Education, Health and Care Plan |
| NHS | National Health Service |
| NHS Sussex (ICB) | Local health integrated care board area |
| SCDS | Specialist Community Disability Service |
| PB | Personal Budget |
| DP | Direct Payment |
| PA | Personal assistant |
| EOTAS | Education Other than at School |
| LO | Local Offer |
| DBS | Disclosure and barring service |
| PTB | Personal Transport Budget |
| PHB | Personal Health Budget |
| EPB | Education Personal Budget |
| HMRC | His Majesty’s Revenue and Customs |
T attends a Local Authority (LA) maintained special school in the city. The school place meets almost all of T’s needs, but he has a rare disorder that requires some specialist services not normally a part of the school’s offer. These services are part of the provision in T’s EHC Plan and the Headteacher has agreed for these to be delivered in school. T’s parents asked for a personal budget to buy in the additional services required. The LA agreed and T’s parents receive a direct payment for the additional services required. These are all delivered in school as the Headteacher has agreed to support this holistic approach.
P attends a mainstream academy in the city with a current EHC Plan. The high needs top up funding is being used by the school to meet H’s needs. However, her parents have requested for some of her PE curriculum time, that she attends a specialist PE session off site for the year. This would be an additional cost that her parents could not afford to pay for. However, if the Headteacher agrees, as long as parents are prepared to collect her from school and transport her to the session every week. The specialist PE session does meet some of her occupational therapy and behavioural needs that are not so easy to meet in school. The Headteacher has calculated the cost of the provision and has agreed this can be funded by the element 2 funding that the school put into her overall personal budget. As the Headteacher has agreed this is supported by the local authority and a ‘notional’ budget set aside that is used to fund the session. The physical outcomes that are in H’s EHC Plan are being met.
R is a KS3 pupil with high functioning ASD and behaviour that challenges. He has an EHCP but has found secondary school increasingly challenging, and his attendance has plummeted. His school has been using some of the EHC Plan funding to provide input at home, but this has gone on for a term now and no improvement in attendance has happened. R’s parents asked for a change of school but no schools in the local area could admit him. R’s parents then asked for a package of support to meet his needs outside of school (this is known as Education Other than at School (EOTAS)). As no local school could be found, this was agreed. The LA had a standard KS3 EOTAS package that was arranged for R. However, this did not meet all the needs and outcomes in his EHC Plan. R’s parents applied for a personal budget to meet these additional needs and outcomes. The request was agreed for a time limited period of one year with the agreement to seek a destination school, dependent on adequate progress being made in his academic and social and emotional skills. R’s parents agreed for the LA to hold the ‘notional’ personal budget and commission the additional services to meet his needs. The focus was on behavioural and mentoring support to reduce R’s anxiety and assist him in being able to attend small group sessions.
C is 17 years old. She tried to transition to sixth from college following school. She did well and achieved 5 GCSE passes with the support detailed in her EHC Plan. It was hoped that she would be able to manage 2 A level courses, but the pressure was too great. She did try to move to a more vocational course at a local college but, by this time, she was too anxious. In the past she had had CAMHS input, but this was no longer available. C’s mother asked for a programme of support to enable her to rejoin her studies at college if this was successful for the rest of the academic year. Her programme consisted of basic tutor hours, small group work, mentoring and employment support service. Her mother received a direct payment to fund mentoring support for a period of 12 weeks whilst the LA arranged the other support. The support plan had clear goals to reengage C in KS5 for the following academic year.
K and S are 12-year-old twins, both have complex health needs. One is eligible for children’s continuing care support; one is not eligible. Both have direct payment workers via social care.
The family has chosen to have a Personal Health Budget (PHB) as a direct payment so they can employ some workers directly; these are health trained via the PHB agreement and are able to undertake health tasks. PHB hours and Social Care DP hours can be used flexibly to support the family.
H is 8 years old with behaviour that challenges and seizures. He has a small direct payment package via social care for washing and dressing assistance and accessing the community with family and siblings. H became eligible for personal health budget funding due to his seizures worsening. Mum requested a PHB as she wanted short periods of support throughout the week (these shifts can be hard to commission via agencies as they often have a minimum of 4 hour shifts). Now PHB workers are employed with specialised training for his seizure management.
J is 18 years old and lives with parents and older siblings. J would like to live independently but needs support to reach a point where that would be possible. Local services have been tried for independence training, but it has been agreed that
J needs more 1:1 help with day-to-day skills and he may need some level of ongoing 1:1 support in an independent setting. A personal budget of 6 hours per week PA support has been agreed to work on independent living skills to see if J can acquire these and how much ongoing support he would need if he were to live independently or in a supported living environment.
Sam is Y’s mother and cares for Y. Y is secondary age and attends a special school. Y has access to specialist short breaks. Sam has 2 younger children and feels they get little of her time as Y is so demanding. A strengthening families assessment has been carried out for support for Sam to then be able to spend time with the other children. Y will then have a total of 3 days PA support over 2 weeks paid as a DP.
This is in addition to Y’s access to short breaks respite care.
B is 16 years old with complex needs and challenging behaviour. He needs an adult with him at all times when he is out in the community. He attends a specialist post 16 school placement. Rizwana, B’s mother is a single parent and although she manages well at home, she cannot leave B alone. She needs some time to herself and B needs to begin to learn how to manage better in the community. B already has specialist short breaks respite in a local residential provision for 3 nights per month. However, Rizwana needs some additional hours in the week for B to get out and for her to have time alone. B is awarded 5 hours per week of PA support to help him with basic life skills and to give Rizwana a break on 2 evenings after school. B has a positive relationship with his support worker and he is learning local travel routes, basic shopping skills and is getting support to attend a local specialist youth group (short break provision).
J is eight years old and has a learning disability and autism. He attends his local primary school. He has an EHC plan which does not include any additional support from health as Jalen is fit and well. The plan does include 20 hours additional support in J's school.
The plan also includes ten hours support from social care as his mother is a single carer and has three other children. She decides that she would like to keep Jalen's transport assistance in place and does not want the responsibility of having a direct payment.
She asks for the money from the support provided in school and from social care to be 'pooled' and for one agency to be asked to provide both so that there is consistency for J. This also means that if J is unwell and cannot attend school, the support worker can be with him at home. This can only be done with the agreement of the school, which has to agree any support provided in school.
M is ten years old and has complex epilepsy and global developmental delay. He attends a local special school and has an EHC plan. He lives at home with both his parents and three younger brothers and sisters. His father works full-time and his mother stays at home to care for M and his siblings.
Additional health and social care support is set out in M's EHC plan. This includes 38 hours support at home, including some overnight provision to help him to get ready for school.
The family chooses to have a personal budget to pay for M's care and they ask for the money to be paid as a direct payment into a supported bank account. They employ a team of two personal assistants which enables M's parents to be able to take control of the people coming to their home and to build strong trusting relationships with the personal assistants they have taken on.
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