DIRECT PAYMENT AGREEMENT
Agreement between NHS Kingston Clinical Commissioning Group and the recipient of a direct payment as part of a personal health budget
This Agreement is made on [insert date] between:
[insert patient's name and address] (referred to as "you");
and
NHS Kingston Clinical Commissioning Group of 3rd Floor, Guildhall One, Kingston, Surrey KT1 1EU (referred to as "we").
What is this Agreement for?
(a) We may, subject to certain conditions, make payments directly to patients (or their nominee or representative) to meet their healthcare needs.
(b) This Agreement is based on Section 12A of the National Health Service Act 2006 (as amended by Health and Social Care Act 2012) and the National Health Service (Direct Payments) Regulations 2013, as amended. The Regulations will apply to this
Agreement, and you, your representative or nominee (as applicable) can find out more information about these regulations at these websites:
NHS England updates on personal health budgets
http://www.personalhealthbudqets.enqland.nhs.uk/News/item/?cid=8694 National Health Service (Direct Payments) Regulations 2013
http://www.leqislation.qov.uk/uksi/2013/1617/pdfs/uksi 20131617 en.pdf National Health Service (Direct Payments) (Amendment) Regulations 2013 http://www.leqislation.qov.uk/uksi/2013/2354/pdfs/uksi 20132354 en.pdf
We cannot give you, your representative or nominee (as applicable) advice about the law, but if you have any questions about these regulations, please ask Citizens Advice Bureau for help: http://www.citizensadvice.orq.uk/
Kingston Citizens Advice Bureau
Neville House, 55 Eden Street, Kingston, KT1 1BW Telephone: 020 3166 0953
(c) In certain circumstances, including where you are under 16 or are unable to consent to your direct payment, someone else may legally receive and
manage your direct payment on your behalf. That person is called a representative. Where we agree to it, your representative will receive and manage the direct payment on your behalf, and will sign and agree to the terms of this Agreement on your behalf.
Your representative is, if applicable and agreed by us: Representative:
Address:
Relationship to you:
(d) You, or your representative, is entitled to appoint someone else to receive the money on your behalf, and spend it for you. That person is called a nominee. Where you, or your representative, wish to use a nominee, we must agree who this person will be. Where we agree to it, your nominee will receive and manage the direct payment on your behalf, and will sign and agree to comply with the terms of this Agreement and any other obligations on them under the Regulations.
Your nominee, if applicable, is: Nominee name
Address
Relationship to you 1. Definitions
"Agreement" means this agreement between us and you, including the annexes at the end of this agreement
"Care Coordinator" means the person named as such in the support plan
"direct payment account" means the bank or building society account that we agree to pay the direct payments into, subject to restrictions imposed by Clause 4.5
"direct payments" means the payments we will make into the direct payment account, as set out Clause 2
"nominee" means your nominee (if applicable) who will receive and use your direct payments on your behalf to procure support for you under your support plan
"Regulations" means the National Health Service (Direct Payments) Regulations 2013, including any amendments
"representative" means your representative, if applicable, who will receive and use your direct payments on your behalf to procure support for you under your support plan start date" means the date of this Agreement
"support plan" means the plan setting out the support you require and that you, your representative or your nominee (as applicable) will pay for, using the direct payments
2. Payments
2.1 Subject to the terms of this Agreement, we agree to pay you (or your representative or nominee on your behalf, as applicable) the direct payment(s) on a 4 weekly basis.
2.2 We will pay the direct payments into the direct payments account. On the start date we will pay (in accordance with the support plan)
£[ ] [and will then pay £[ ] every month].1
1
Square brackets to be deleted, as applicable, depending on whether the direct payment will be paid monthly or this is a one-off direct payment.
2.3 You, or your representative or your nominee (as applicable), must follow our Financial Procedures in respect of the direct payments and direct payment account as set out at Annexe 1.
3. Our rights and responsibilities
3.1 We will assist you (or your representative or nominee) to write a support plan for you and agree this with you (or your representative or nominee on your behalf, as applicable). Alternatively, if it's easier we can write the support plan for you (with you, your representative or nominee's assistance) and agree this with you. We will tell you (or your representative or nominee, as applicable) about any significant potential risks arising in relation to the direct payments and agree a procedure to help you (or your representative or nominee, as applicable) manage such risks. We will appoint a Care Co-coordinator to assess and agree your support plan with you, your representative or your nominee (as applicable).
3.2 The Care Coordinator or another designated officer or agent acting on our behalf shall monitor the making of the direct payments and your health condition, in respect of which the direct payments are made at his/her discretion, and by such means and at such intervals as s/he considers are required.
3.3 We will review the direct payments in accordance with our obligations under the Regulations. With regard to timing, the Care Coordinator will review the direct payments and support plan at least once within the first 3 months of your first direct payment. They will then review again at least once a year, and will tell you (and your nominee or your representative) in writing the result of such reviews. You will co-operate (or your representative or your nominee will procure that you will co-operate) with any review of your support plan.
3.4 The Care Coordinator may also review the direct payments and support plan where you notify him/her that your health has deteriorated (or your representative or nominee notify us on your behalf). The Care Coordinator must also review the direct payments and support plan where he/she becomes aware or is notified that the direct payments are not sufficient to secure the services specified in the support plan.
3.5 We may amend your support plan, and pay you (or your representative or nominee, as applicable) more money, or less money, following a review in accordance with the Regulations. Where we reduce the amount of direct payments following a review, we will provide you (or your representative or nominee, as applicable) with one month's notice and provide you with reasons for the decision. You, or your representative or nominee (as applicable) can ask us to re-consider this decision once more, and provide us with evidence to look at, and we will write to let you know our final decision thereafter.
3.6 We and our agents are not responsible for any claims, damages, losses, liabilities, costs, expenses and demands arising from the support or care provided to you by providers employed or engaged by you (or your representative or nominee) using the direct payments and pursuant to your support plan.
3.7 We will make arrangements for you, your representative or nominee (if applicable), to obtain support, information and/or advice you need to enable the effective management of the direct payments. We may tell you, your representative or nominee (as applicable) not to buy support using the direct payments from a particular provider and we will let you (or your representative or nominee, as applicable) know if there is someone we do not want to be used. Notwithstanding this Clause 3.8, you, your representative, or your nominee (as applicable), are responsible for buying and managing any support purchased with your direct payment and we will not enter into contracts with any providers on your behalf.
3.8 We consider that it is appropriate and that you, or your representative or nominee (as applicable), are willing to receive a direct payment for health care, and able to manage the direct payments according to arrangements described in the support plan agreed with us.
4. You, or your representative or your nominee's (as applicable), rights and responsibilities
Willingness to receive a direct payment for health care and to be responsible for buying and arranging your support as agreed with us
4.1 You, or your representative, or your nominee (as applicable), agree that the support in your support plan will be enough to care for you. You, or your representative or your nominee (as applicable) can change your support plan if you want to, but only if it is agreed with us first. You, your representative or your nominee (as applicable) agree that the amount of direct payments we pay into the direct payment account will be enough to pay for the support you need as agreed under the support plan.
4.2 The direct payments will be managed according to arrangements described in the support plan. You, or representative, or nominee (as applicable), must follow all the rules that we require as set out in Annexe 1 and you must keep records and must let us, or someone else we choose, check these records when we want to.
4.3 You, or your representative, or your nominee (as applicable), must tell us about aspects of your health that relate to your support plan when asked.
4.4 If your health changes in a way that will affect your support plan, or anything to do with the direct payments we pay, then you, your representative or your nominee (as applicable) must tell the Care Coordinator straight away.
4.5 You, or your representative, or your nominee (as applicable), can reasonably request the Care Coordinator to look again at the direct payments and support. We will decide whether to carry out a further review, and let you, your representative or your nominee (as applicable) know what we decide.
4.6 You, or your representative or your nominee (as applicable), agree that the direct payments account (the account that we pay your direct payments into) will only be used for your health and care in the way that we agree in your support plan. The direct payments account can be used for other money that the government may give you for care or services, but you, your representative or nominee (as applicable) must tell us if this is the case. Except where you, your representative or your nominee (as applicable) is receiving a one-off direct payment from us, the direct payment account shall be a separate account and not yours (or your nominee's or representative's) own personal or home banking account.
4.7 You, your nominee or your representative (as applicable) agree to be responsible directly or through an agent for the employment of people or engagement of self-employed persons or other independent agents able to provide assistance as identified in the support plan.
4.8 You, your representative and/or your nominee (as applicable) agree that we have made reasonable arrangements for you, your representative and/or nominee (as applicable) to access or obtain information and support relating to the receipt and use of the direct payments.
4.9 You, your representative or your nominee (as applicable) will ensure that the direct payments are used only for the purposes of purchasing the support specified in the support plan. You, your representative or your nominee (as applicable) will notify the Care Coordinator if at any point the direct payments cease to be used for your health care in accordance with the agreed support plan. Such notice shall be confirmed in writing as soon as possible.
4.10 You, your representative or your nominee (as applicable), will be expected to ensure that provision has been made to cover emergency situations (e.g. in the event of a breakdown in your usual care arrangements).
4.11 You, your representative, or your nominee (as applicable) will not "top up" or add to the direct payment account with your or other family resources/money.
If you, or your representative, or your nominee, pay someone to help you, using the direct payments
4.12 If you, your representative or your nominee (as applicable), pay someone to help you using the direct payments, then you may be considered to employ them. If you employ any person using direct payments, you, your representative or your nominee (as applicable), must comply with the law, including Her Majesty's Revenue and Customs (HMRC) requirements (to make relevant statutory returns, and pay all tax and national insurance contributions due to HMRC), and all health and safety, equal opportunities, and employment law.
4.13 If you, your representative or your nominee (as applicable), employ someone using the direct payments from us, you will ensure the use of appropriate contracts of employment. A suitable contract template will be provided by Kingston Centre for Independent Living (KCIL), upon request.
4.14 If you, your representative or your nominee (as applicable), decide to employ someone you do not know, they must have an enhanced Disclosure and Barring Service (DBS) check to ensure that the person does not have any relevant criminal convictions, which would make them unsuitable to do the sort of job proposed. Where appropriate, the enhanced DBS check will be arranged by us and/or our agent. Where the results of enhanced DBS checks demonstrate the unsuitability of the person for the work involved, you, your representative or your nominee (as applicable) will not employ that person using direct payments. Where you, your representative or your nominee (as applicable) decide to employ someone you do know (e.g. a family member or friend), an enhanced DBS checks may be undertaken if you, your representative or your nominee chooses.
4.15 You, your representative or your nominee (as applicable), shall not secure or purchase services using your direct payments from a partner or close relative of yours who lives in the same household as you without our written permission (as defined in Annexe 2 to this Agreement). We will consider such requests only in exceptional circumstances, where your health and wellbeing needs cannot be met in any other way.
4.16 Anybody employed or otherwise engaged using the direct payments will not be our employee or our agent, and we are not responsible for any income tax or national insurance contributions or any other payment payable by or in respect of the personal assistant so employed or engaged.
4.17 Where you, your representative or your nominee (as applicable) employs or otherwise engages someone to provide services using direct payments which requires professional registration with a professional body (e.g. qualified nursing care), you, your representative or your nominee (as applicable), must ensure that the person is appropriately registered. You, your representative or your nominee (as applicable) may not waive any requirement for such registration. Where requested, we or our agent will use all reasonable endeavours to check individual professional registrations on your behalf.
4.18 You, your representative or your nominee (as applicable) will not use the direct payment for healthcare to purchase a regulated activity from an unregistered provider. Liability insurances
4.19 If you, your representative or your nominee (as applicable), employ someone to help you, you must have employer's liability insurance (which includes public liability insurance). This must be with reputable insurers or underwriters and the insurance must have a minimum value of £10 million [in aggregate]. The insurance must have a minimum limit for any one claim of £1 million (the limit may need to be increased from time to time as reasonably required by our Chief Finance Officer). The relevant insurance policy or policies and the premium receipts must be produced as and when required by us or our agents. The direct payments will have enough money to pay for these
insurance policies and will be taken into account when agreeing your support plan.
Keeping financial and other records, and making them available for inspection
4.20 You, your representative or your nominee (as applicable), will keep for 6 years all documents/records in connection with the support plan and direct payments for our and/or our agents' inspection, on request. This may include
review by the Kingston CCG Internal Audit Service or other
agents acting on our behalf. You, your representative and your nominee (as applicable), will follow the Financial Procedures set out in Annexe 1.
5. Stopping or repayment of direct payments
5.1 You, or your representative or your nominee (as applicable), can end this Agreement by giving 28 days' notice in writing to the Care Coordinator (unless you have agreed a different notice period).
5.2 This Agreement will terminate with immediate effect if you, your representative or your nominee (as applicable) withdraw consent to receive a direct payment in accordance with this Agreement or you withdraw your consent for your nominee to receive the direct payment on your behalf.
5.3 We may choose to end this Agreement by giving 28 days' notice in writing, with reasons for such a decision. Our reasons may be that:
5.3.1 your representative or nominee (if applicable) is no longer considered appropriate by the CCG to receive direct payments on your behalf (if applicable) 5.3.2 your nominee or representative refuses to take the direct payments on your behalf
5.3.3 there has been theft, fraud or another offence in connection with the direct payment
5.3.4 your health needs can no longer be, or are not being, met by services secured by means of direct payments and direct payments no longer work for you
5.3.5 we decide that you are no longer eligible to receive NHS continuing healthcare payments from us.
5.4 If we do write to you, your representative and/or nominee (as applicable) under Clause 5.3 to end the Agreement, then you or your representative or nominee can ask us to re-consider. You, your representative or nominee (as applicable) can tell us the reasons why you think the Agreement should not end, and we will consider and write to you, or your representative or your nominee (as applicable), to confirm what we decide and why. We are not under any obligation to re-consider our decision again following this.
5.5 We may require all or some of your direct payments to be paid back to us, including where we find out that:
5.5.1 the direct payments have been used otherwise than to procure support specified in the support plan;
5.5.2 a substantial proportion of the direct payments received have not been used and have accumulated.
5.5.3 there has been theft or fraud in connection with the direct payments 5.5.4 your support plan or circumstances have changed substantially,
and we will give you, your representative or your nominee (as applicable), reasonable notice of such a requirement to repay direct payments, such notice to include the reasons for the decision and how much is to be repaid.
5.6 If we tell you, your representative or your nominee (as applicable) that any, or all, of the direct payments must be paid back, then you or your representative or your nominee (as applicable) can ask us to re-consider our decision. You, you representative or nominee (as applicable) can give us evidence or information to look at and we will write to confirm what we decide and why. We are not under any obligation to re-consider our decision following this.
6. General
6.1 If we change anything about this Agreement, then you, or your representative and/or nominee (as applicable) must agree any changes. You will have to sign and date a written notice of the changes and your representative and/or nominee, if applicable, can sign for you.
6.2 If we want to tell each other anything about this Agreement, then this should be in writing, with a printed or handwritten copy delivered to the address below:
Kingston Clinical Commissioning Group: Your address:
Representative's address (if applicable): Nominee's address (if applicable): 6.3 The date of a written notice to be:
6.3.1 if delivered by hand, the date when this is delivered; 6.3.2 if by post, two working days.
6.4 This Agreement follows the laws of England and Wales.
6.5 If we have made any other Agreement between us about direct payments, this Agreement will take precedence.
6.6 If a Court decides that any part of this Agreement is not valid, the remainder of the Agreement will remain in force.
6.7 This Agreement will end straight away if the law changes in a way that makes it unlawful for us to make direct payments. If that happens, then you, your representative or your nominee (as applicable), will have to pay back any money that has not yet been spent, that we gave to you or to your representative or to your nominee.
Signatures
Signed by [ insert patient name ] Signature:
Date: Name: Address
Signed by the Representative (if applicable), on behalf of [ Signature:
Date: Name: Address:
Signed by the Nominee (if applicable) Signature Name:
Date: Address:
Signed on behalf of Kingston CCG Signature:
Name: Job Title: Address:
2
Where the patient has a legal representative (because they are under 16 or lack capacity to consent) then the signature block by the patient can be removed.
Annexe 1 FINANCIAL PROCEDURES FOR PERSONAL HEALTH BUDGETS HOLDERS All transactions will go through a direct payment account. The direct payment account may be nominated solely for your direct payments (in accordance with Clause 4.5) or may be your personal bank account where only a one-off direct payment is made under this Agreement.
All charges on the account will be your, your representative's, or your nominee's responsibility.
Payments out of the account should only ever be to meet the needs and outcomes identified in the support plan.
Payments out of the account should be made by bank transfer/cheque. In any event, receipts, statements or payroll documentation should be available on demand to substantiate all payments.
You, your representative or your nominee (as applicable), should retain for audit purposes (for 6 years after we have paid the first direct payments):
Bank statements, cheque and paying-in books Invoice and receipts
PAYE, N.I and other payroll records
A note of how much money we have paid and how you, your representative or your nominee have used the money.
We may ask you, your representative or your nominee (as applicable), to retain other information, upon request.
You, or your representative, or your nominee, must keep the statements that the bank sends you each month. You will be responsible for checking the statements and highlighting any discrepancies, making a note of any action taken or problems on a regular basis.
Annexe 2 WHO YOU MAY EMPLOY
In general you, your representative or nominee, may not use direct payments for health care to secure a service from:
Your spouse or partner (i.e. the other member of a married or unmarried couple) or a close relative e.g. parent, grandparent or sibling, living in the same household.
Any person who does not have the legal right to work in the United Kingdom.
Any person employed (or otherwise engaged) to perform tasks for which professional registration (with a professional governing body) is required, where that person does not have the required professional registration.
In exceptional circumstances, we may be prepared to consider allowing you to use direct payments for health care to pay a close relative who lives in the same household as you, provided that we decide that this is the only satisfactory way of meeting your care needs. This will require written confirmation that this arrangement is acceptable from one of our authorised
