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Frequently Asked Questions

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Understanding Direct Payments

What are Direct Payments?

  • Direct Payments are a way of delivering community and continuing healthcare.
  • Their purpose is to increase choice and independence for users by giving more control over support arrangements.
  • The person receiving the Direct Payment is responsible for accounting for how the money is spent.
  • A Direct Payment cannot replace: NHS Services, Housing Services (e.g. Disabled Facilities Grants) or DSS benefit payments.
  • A Direct Payment cannot affect social security benefits nor be classed as taxable income.
  • Direct Payments made by Surrey County Council are subject to the same financial assessment by Surrey County Council as for community care services. Payments made by the NHS are not subject to financial assessment.
  • There is no maximum or minimum level to a Direct Payment.
  • It must be cost-effective and sufficient to pay for support of a quality acceptable to the authority.
  • A Direct Payment must be sufficient to enable the recipient to meet their legal obligations.
  • People receiving Direct Payments can choose to mix the services they buy and can opt to cease using Direct Payments at any time.

Who can receive Direct Payments?

  • Older and disabled people aged 16 and over who are assessed as needing services. All impairments are included (physical, sensory, learning, HIV and AIDS, emotional) but people subject to certain mental health after care or criminal justice legislation may not be able to receive Direct Payments.
  • A person with parental responsibility for a disabled child.
  • Carers aged 16 and over who are caring for a disabled adult.
  • People must be willing and able to manage Direct Payments, alone or with assistance.

What can a Direct Payment be used for?

  • It can be used to employ personal assistants or purchase support that the Local Authority or NHS is satisfied will meet that person’s assessed needs.
  • Unlike services arranged by the local authority or NHS, with a Direct Payment, the user is responsible for ensuring the quality of the services received.
  • A Direct Payment cannot be used to purchase permanent residential care or services provided directly by the local authority or the NHS.

Keeping Financial Records

A prepaid account was introduced in Surrey in 2015 as an additional way to manage the money side of a direct payment.

Under this arrangement, a separate bank account is set up for you by Surrey County Council, who then make payments into it, usually monthly. You can then pay for the things in your support plan from this account by standing order, direct debit or electronic transfer (for example, internet banking or telephone banking). Actual cash should not be withdrawn from the account.

If you choose the prepaid account for your Direct Payment, you won't be required to submit reconciliation forms to Surrey County Council, as they can view a record of the transactions made on the account at any time.

If you are having your money paid into your own separate bank account you will need to complete quarterly reconciliations and return them to the council along with copies of the relevant bank statements.

SILC are able to help you with these reconciliations but there is a charge for this service details of which are available by contacting the SILC office.

With both the payment methods you should get and keep receipts and/or invoices for any payment you make from your prepaid account.

For NHS payments:

If you are having your money paid into your own separate bank account you will need to complete quarterly reconciliations and return them to the NHS along with copies of the relevant bank statements.

SILC are able to help you with these reconciliations but there is a charge for this service details of which are available by contacting the SILC office.

Do I need to keep receipts for any money I spend?
Yes. You should get and keep receipts for any payment you make from your prepaid account.

Recruiting a Personal Assistant

Can I get help with recruitment?

SILC can give you advice and assistance with recruitment, including the drafting and placement of advertisements and the arrangement of interviews.

Who pays for the recruitment advertisement?

The reasonable cost of advertising is covered by your Direct Payments in the form of an initial set up payment.

Do I have to have an Equal Opportunities policy?

Although you do not have to have an Equal Opportunities policy you must not (by law) discriminate on the grounds of race, sex, disability, age, religious belief or sexual orientation.

Do I need to take up references for someone I wish to employ?

Before employing anybody, you should obtain references from two people who know the applicant well. SILC can help with this.

How can I check if the person I want to recruit has a criminal record?

SILC can help you obtain a Disclosure and Barring Service (DBS) check on any prospective employee.

Employing a Personal Assistant

Can I employ someone from outside the UK?

You can employ someone from any country in the EU without the need for a work permit but you must ensure that anyone you employ is legally entitled to work in the United Kingdom. You should ask to see relevant documentation and keep copies of it. SILC can help you with this.

Can I employ my partner or one of my relatives?

You cannot employ any close relative or partner who lives with you without prior permission from Social Services or the NHS, and then only in exceptional circumstances. Exceptional circumstances are only usually agreed where there is no other way of providing the required care.

When and how should I offer someone a job?

Any offer of employment should be made in writing and subject to satisfactory references. SILC can help with drafting an offer letter.

Can I employ someone for a trial period to see how they get on?

It’s a good idea to include a probation period in any offer of employment. We suggest a trial period of 13 weeks.

Do I need to provide a job description?

Yes. It’s best to draw up the job description before you offer someone the job – we can help you with this.

Is there anything else I should give my new recruit?

No later than eight weeks after starting work, the new recruit is entitled to receive a statement of main employment particulars. SILC can help you with this.

Is there a limit on the number of hours I can ask my Personal Assistant to work?

Yes. You cannot ask someone to work more than the Working Time Regulations limit of 48 hours per week, unless they agree in writing to do so. SILC can give you advice about this.

How much should I pay my Personal Assistant?

You must pay at least the National Living/Minimum Wage per hour, before tax. SILC can give you advice about this.

Do I need to take out any insurance before employing someone?

You need to take out Employers' Liability insurance. The cost of an appropriate policy is included in your Direct Payment and application forms are available from SILC.

Do I have to pay my Personal Assistants holiday pay?

All employees are entitled to the pro rata equivalent 5.6 weeks of paid holiday a year. The cost of holiday pay, and of employing another PA to cover for holidays, is included in your Direct Payment. SILC can help you to calculate how much holiday each of your employees is entitled to.

Do I have to pay my Personal Assistant when they are sick or on maternity leave?

Your employees may be entitled to Statutory Sick Pay or Statutory Maternity Pay in the relevant circumstances. Contact SILC for advice before you make any payment.

What happens when I need to pay for cover for my Personal Assistant?

An amount of money for contingency cover is included in your Direct Payment.

What happens if my Personal Assistant becomes pregnant?

Pregnant employees have special legal rights. You cannot refuse someone a job or dismiss her just because she is pregnant. If one of your employees is or becomes pregnant, contact SILC for advice.

What happens if my Personal Assistant has a disability or becomes disabled?

Disabled employees have special rights. As you probably know, the term "disabled" covers a wide variety of physical and mental impairments. If you have reason to believe that one of your employees is or has become disabled, you should contact SILC for advice.

What happens if I want or need to sack a worker?

All employees have legal rights relating to grievance and disciplinary procedures (including dismissal and redundancy procedures). If you fail to follow the correct procedure you could be taken to an employment tribunal and have to pay compensation. If you are faced with a potential grievance, disciplinary or redundancy situation you should contact SILC for advice before taking any action.

What do I have to do about Health and Safety?

You have all the legal obligations of any employer, except that you are not strictly bound by the Health and Safety at Work Act when employing someone in your own home, however, you remain bound by a general duty of care and should take our advice on this.

Can my Personal Assistant be self-employed?

It is extremely unlikely that HMRC will regard people working regular hours for you as being self-employed. Any person wishing to be regarded as self-employed should be asked to produce written authority from HMRC that it is prepared to regard them as self-employed. Otherwise they must be treated as being directly employed by you.

Paying your Personal Assistant

Can I pay in cash?

No. You should not pay any worker in cash and it is against Surrey County Council and NHS policy for you to do so. If this presents any problems, contact SILC for advice.

Should my Personal Assistant fill in time sheets?

Yes. Ask your Personal Assistant to complete a time sheet for all the hours they work (preferably on a weekly basis) and get them to sign it. You should keep a copy of these so that you can avoid disputes about hours worked.

Do I have to sort out Income Tax and National Insurance?

You are liable to HMRC for deductions of any Income Tax and Employee’s National Insurance and for any Employer’s National Insurance contributions due. These deductions need to be held back from gross pay and paid to HMRC as required. The cost of tax and National Insurance contributions are included in your Direct Payments and SILC can help you budget to cover these.

Can I use a payroll service to pay my workers?

Yes. SILC can put you in touch with a payroll administration service, the cost of which can be met by your Direct Payment. The payroll service will calculate the necessary deductions and print a pay slip for you to give to your employees as is legally required. You must provide details of hours worked and pay rates, and of the employee's tax details.

Can I do my own payroll?

Yes. You can operate your own payroll by contacting HMRC.

NHS Health Complaints Advocacy

How does the advocacy service work?

If you would like some help and support in making a complaint about the NHS you can contact us by telephone or email. We can give you information to help you raise your complaint yourself, and can also provide you with an Advocate to work with who can help you write letters to the right people, go to local resolution meetings with you, help you to explore your options, act on your direction and answer questions to help you make decisions about your complaint. The advocate can’t tell you what to do or make decisions for you though.

How long do I have to make a complaint?

You should submit your complaint within 12 months after the event you wish to complain about or 12 months after you have realised that you need to complain. If you make a complaint outside this timeframe, then the NHS may not consider your complaint.

How long will it take for my complaint to be resolved?

This can vary widely and depends on the organisation that provided your treatment, but it is likely to take around 2-4 months to get through the first stages. However, if the complaint goes on to the Ombudsman, this can take in excess of 1 year.

Can you come with me to medical appointments?

No. Our NHS complaints advocates can attend local resolution meetings with you as part of the NHS complaints process but cannot attend medical appointments with you.

Can you support me with non-NHS complaint related advocacy?

No. Our service only provides NHS complaints advocacy. For other forms of advocacy, please contact Advocacy in Surrey. Their website is and their phone number is 0800 335 7330.

Can you help me get compensation?

We cannot support you to claim compensation as this isn’t part of the NHS complaints process. Compensation is usually only possible through legal action and you will need to speak to a solicitor who specialises in medical or clinical negligence. A claim must be made within three years of the incident happening or you realising that you have something to complain about.

The Law Society can help you find a solicitor in your area. Their helpline is open from 9am to 5pm, Monday to Friday, and the number is 020 7242 1222. Their website is

Action against Medical Accidents (AvMA) is a medical charity that may help or guide you with regard to medical accidents. Their helpline is open from 10am to 3.30pm, Monday to Friday, and the number is 0845 1232352. Their website is

The Legal Aid Agency provides criminal and civil legal aid and advice to help people deal with their legal problems. Their number is 0300 200 2020 and their website is

Can you help me get someone fired/disciplined/struck off?

We cannot support you to pursue getting a member of NHS staff disciplined, fired or ‘struck off’ as this isn’t part of the NHS complaints process. To complain about an individual’s fitness to practise, contact the appropriate professional regulatory body.

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