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This publication is available at https://www.gov.uk/government/publications/coronavirus-covid-19-guidance-for-people-receiving-direct-payments/coronavirus-covid-19-qa-for-people-receiving-a-personal-budget-or-personal-health-budget
A priority for this government is that everybody receives the care and support they need throughout the COVID-19 pandemic. This applies as equally to people who receive their care and support through direct payments, as it does to people who receive care and support in other ways. For direct payment holders, we know that direct payments can enable you to have more choice and control over your care and support needs so that you can put in place the care and support that works for you, and allows you to achieve the goals you want to achieve.
We recognise that during this time, direct payments can bring their own unique challenges. For example, if you previously used your direct payment to join community classes, this might not be possible at the moment. Similarly, if you usually use your direct payment to employ personal assistants (PAs), you may be experiencing changes – for example, if you or your PA has COVID-19 symptoms. We understand that this can be a difficult and uncertain time.
That is why we want to use this document to set out, clearly, what you should expect. There is nothing in the Coronavirus Act or the Care Act easements guidance which suggests that direct payments could be stopped – instead there should be greater levels of flexibility, to ensure you continue to receive the care and support you need to keep safe. To achieve this, there should be discussion between yourself and local authorities (LAs) and clinical commissioning groups (CCGs) to make sure you receive the support you need during the COVID-19 outbreak. Your safety, and those who provide care and support to you, is vital. That is why you should be able to access the appropriate personal protective equipment (PPE) and testing for those who provide care and support for you.
Overall, during the COVID-19 outbreak, there is absolutely no reason why your direct payment should not continue to meet your care and support needs in the best way for you and the goals you want to achieve. The key messages in the direct payment guidance during the COVID-19 pandemic are:
a. Your direct payments should continue as before. These remain as important as other types of provision, and LAs and CCGs should make every effort to ensure that your budget and payment are maintained and supported.
b. LAs and CCGs should communicate with you to ensure you stay safe and are assured about the LA/CCG’s concern for your wellbeing.
c. The government expects LAs, CCGs and direct payment holders to adopt and enable the most flexible possible use of your direct payment to manage any issues arising from COVID-19. In emergency or time-critical circumstances, you have the flexibility to use your payment in a way that ensures you safely receive the care and support you require. This could mean a variation in your agreed care and support plan which does not require immediate sign-off from the LA or CCG, on the basis that it’s the right thing to do so you stay safe and receive the care and support you need during this time.
d. The government consider all PAs to be key workers, meaning they are eligible for provisions such as care for their children at local schools and PPE.
e. Everybody with symptoms – including PAs, unpaid carers and yourself – is eligible for testing. This includes home tests, delivered to your door if that is what you would like. In some cases people without COVID-19 symptoms will also be tested, to inform any clinical diagnosis.
f. Accessing appropriate personal protective equipment (PPE) for people who support you is essential. Where there are difficulties in getting hold of the appropriate PPE, LAs and CCGs will help you source this.
g. You can use the Coronavirus Job Retention Scheme to furlough those you employ where necessary, but it’s important that you keep employing people who provide you with care and support where possible, and safe to do so. Examples and case studies on appropriate and inappropriate use of the Coronavirus Job Retention Scheme can be found alongside this guidance.
Who this document for
This document is aimed at people of all ages ‒ children, young people and adults ‒ who receive support through their personal budgets or personal health budgets and take this as a direct payment. It’s also relevant to family members, local authorities (LAs), clinical commissioning groups (CCGs), providers and people who are employed through a direct payment, including PAs (including those who are self-employed).
It sets out key messages to support people in planning and receiving their care safely during the pandemic, including slowing the transmission of the coronavirus (COVID-19) and reducing the possibility of hospital admission or care breaking down.
It takes account of the latest advice issued by government, including the Care Act easements guidance. It also takes into account the ethical framework for adult social care. This framework provides support to councils’ ongoing response planning and decision-making during the pandemic to ensure that consideration is given to a set of ethical values and principles when organising and delivering social care for adults.
This document has been developed by the Department of Health and Social Care (DHSC) based on questions and concerns raised by members of the public. Contributions to the document have also been made by a number of government departments, organisations and charities, including Think Local Act Personal (TLAP), In-Control, Skills for Care, Local Government Association staff (LGA), ADASS staff, NHS England and NHS Improvement, including the Personalised Care Strategic Co-production Group, and the National Co-production Advisory Group (NCAG).
This document will be updated to take into account any new relevant guidance published, and also to respond to any new issues or concerns raised by members of the public. For any concerns or questions that are not answered in this guidance (or other published guidance), please email these to email@example.com. These will be considered for future versions of this document.
This document should be read alongside the guidance for commissioners, people receiving direct payments and care providers.
You may also wish to read this document alongside TLAP’s jargon buster a directory of plain English definitions of commonly used words and phrases in health and social care.
Flexible use of direct payments during the pandemic
Using your direct payment during the pandemic
While we’re all having to cope with COVID-19, the government expects LAs and CCGs to continue to give you as much flexibility as possible in how you use your direct payment. What matters most is that you are able to use your direct payment in a way that allows you to stay well and continue to get the care and support you need.
Where possible, you should keep using your direct payment as agreed in your care and support plan. But there may be situations where you need to organise your care and support in different ways as a result of the COVID-19 outbreak.
This is allowed. It has always been possible under the Care Act for you to use your direct payments flexibly providing it continues to meet your needs and keeps you safe. We expect LAs and CCGs to be as flexible as possible when you have made reasonable decisions to use your direct payment differently in a way that keeps you safe and avoids your care breaking down.
Ideally, you will have agreed this with your usual contact person at your LA or CCG, but we understand that this will not be possible every time. This is OK. The Care Act easements guidance says that LAs, providers and direct payment holders should work together to agree the circumstances in how the care package and direct payment can be used differently, without needing sign-off.
Many LAs and CCGs have also now written their own local guidance on how direct payments can be used during the pandemic. If you can access the internet, it’s worth looking at their websites to find advice and support.
When you have to adapt or change your care and support because of COVID-19, you should make a note of what you have done and why and keep any receipts or evidence of how you have used your direct payments. You may need this for future reviews.
Example scenario 1
Joy receives a direct payment that she uses to fund counselling sessions and activities in the community, to support her mental health. The payment helps to reduce isolation. As a result of coronavirus and social isolation, Joy is no longer able to receive counselling, nor can she engage in community activities.
Joy contacted her direct payment support service saying she was feeling vulnerable, anxious and isolated living alone during social isolation. They discussed with Joy how she might be able to feel less isolated, and during the discussion it emerged that she did not have access to a computer.
Joy agreed that if she had one, she may be able to have online sessions with her counsellor, could communicate with friends through a video call, and would have access to more leisure opportunities through the internet.
Together, they drew up a plan for Joy to approach her social worker, proposing that she used her budget more flexibly and bought a laptop. Joy’s social worker was very receptive to the idea and approved it. Joy also received training on how to use her laptop through an online tutorial – supported to do this by Joy’s social worker.
Receiving her laptop has changed Joy’s life during the lockdown. Her anxiety and stress levels have fallen dramatically, and she has managed to restart her counselling sessions via video call. This was achieved at no additional cost but has changed Joy’s life and improved her health and wellbeing.
Example scenario 2
Zeenat and Eoin both have autism and receive direct payments to support their wider care needs.
The couple usually enjoy visiting their local pub each day for their favourite meal, which they pay for themselves. When the pub closed as a consequence of the COVID-19 pandemic, Zeenat and Eoin became increasingly concerned and anxious as they could not do this anymore.
Despite having closed, the pub’s landlord kindly offered to continue making Zeenat and Eoin’s favourite meal and leave it on their doorstep. The local authority’s direct payments team agreed that Zeenat and Eoin’s direct payments could be used more flexibly to cover the cost of fuel for the pub landlord to deliver this.
This small change to the direct payment has allowed Zeenat and Eoin to continue to be able to purchase their favourite meal each day. As a result, Zeenat and Eoin feel much less anxious, and this has had a positive impact on their wider health and wellbeing.
Example scenario 3
Hadid is 13 and lives with his mum, dad and younger sister, Sabah, who is 9. Hadid has complex health care needs which means that his whole family are self-isolating.
The family usually have a team of PAs who support Hadid at home and support him when he is outside. However, due to Hadid’s health needs, the family think it would be too risky for his PAs to be coming into the family home. As a result, Hadid’s PAs do not provide that care and support anymore, and Hadid does not get outside as much as he used to.
This change to his life has led to Hadid being anxious about COVID-19. He is also missing his friends at school, who he cannot see anymore. Hadid’s family talk to their social worker about how they could use Hadid’s direct payment differently, that enables him to talk to his friends and manage some of his anxiety. Hadid’s social worker agrees to use some of his direct payment to purchase a games console that enables Hadid to play games online with his friends. Importantly, this allow Hadid to talk to his friends, using a platform that everybody else does.
Together, this has helped Hadid to manage and reduce his anxieties, as he can now talk to his friends when he wants, in a way he wants.
Using your unspent direct payment allocation (contingency funds) and accessing emergency funding from your CCG or LA
You may have a build-up of funds in your bank account, which your LA or CCG has agreed you can keep as a contingency fund, in case you need to pay for additional support at some point. If you need to use this funding due to a COVID-19 issue, you should keep a record so that this can be discussed at the appropriate time.
There may also be occasions where you need to request additional funding in an emergency because you do not have enough money to cover additional costs due to COVID-19. In these circumstances you should discuss this need with your LA or CCG immediately, who will consider this. Requests for additional emergency funding to prevent care breaking down will be prioritised.
Making payments to services you are unable to attend because of government policy (for example, day centres)
You are not required to make payments to services you are now unable to attend unless this is clearly stated in the contract you hold with the service. If this is the case, and you are required to make payments even though you do not receive the service, you should speak to your LA or CCG as soon as possible. They will help you to either make new arrangements, or provide additional funding to ensure that your care and support needs can continue be met.
Covering extra expenses faced by your PA during the pandemic (for example, car park charges if unable to use public transport)
In some circumstances, this will be appropriate, and necessary in order for you to receive the care and support you require during the pandemic (for example, if your PA cannot reach your home without using their own car, in cases where public transport is reduced). It is vital that you continue to receive the care and support you need to remain safe at home, and the government recognises the importance of support delivered by key workers such as PAs.
As an employer, you will need to consider whether the additional expense is essential, appropriate and cost-effective. If in doubt, or if additional funding will be needed, you should discuss this with your named contact at your LA or CCG.
Using your direct payment to pay for activities at home instead of in the community
If you’re unable to attend activities in the community as a result of COVID-19, it is possible to use your direct payment flexibly in a way that will similarly support you to achieve your health and wellbeing goals.
When you want to do this, and if you cannot speak to your LA or CCG about it, you should make a note of what you’ve done and why and keep any receipts or evidence of how you have used your direct payments as they will be needed for future reviews.
Example scenario 4
Miguel receives a direct payment, which he uses to attend a weekly art class at a local community centre. As a consequence of COVID-19, Miguel has been informed that his weekly arts class is temporarily suspended.
The organisation that usually provides the arts class has put learning materials and ideas on its website for people to try at home. Miguel feels it would benefit his health and wellbeing to have the opportunity to continue doing craft activities at home while the community class is suspended. However, he does not have the materials he needs at home.
Miguel contacts his direct payments support service, and with their support draws up a list of materials he needs to purchase. Together with the support service, Miguel finds online sellers and places an order.
The materials arrive and Miguel feels pleased he can participate in the activities suggested online. He continues to develop his skills and maintain his weekly routine. As a result, Miguel is experiencing less anxiety, and is more confident.
Continuation of direct payments
Continuation of direct payments during the pandemic
Your direct payment should continue as before. These remain as important as other types of provision, and LAs and CCGs should make every effort to ensure that budgets and payments are maintained and supported.
Using your direct payment differently because of rules around isolation
In some exceptional cases, the care and support you usually receive may need to change given current government guidance and rules around isolation. For example, if your care and support included going to community classes, this might no longer be possible. Care and support may need to be met in a different way, such as accessing exercise classes through technology, rather than in community settings.
The direct payment guidance encourages LAs and CCGs to provide you with longer-term payments (for example, 2 months’ money rather than one), and therefore you may receive a different amount of money compared to usual. Others are providing extra funding within the direct payment, to cover contingencies. If this does happen, you will be told in advance.
Continuation of direct payments during hospital admission
In general your direct payment should continue. In line with normal practice, this will be dependent on your condition and circumstances, length of stay, and any long-term impacts that mean your needs have changed and are no longer as set out in the care and support plan.
Carer or PA support during your time in hospital
We understand that you may prefer some personal care tasks to be undertaken by your carer or PA rather than hospital staff, which your direct payment can usually allow.
The current visitor guidance provides advice on how NHS organisations may choose to facilitate visiting across healthcare inpatient settings, and includes familiar carers and PAs who may need to attend to support individual needs.
If you will shortly be, or have been, admitted to hospital, you should contact the ward or department you have been admitted to, to talk about your preferences and agree arrangements.
If your carer or PA is able to support you in hospital, they will be subject to infection control measures as is normal practice. In no circumstance should the personal care interfere with the medical treatment. Carers, PAs or anybody supporting you must adhere to the guidance set by government and the hospital around supporting people when in hospital.
Carers and PAs will have a vital role to play upon discharge. Separate guidance has been published on the discharge process in place during the pandemic.
Example scenario 5
Marta is 20 years old, autistic and has learning disabilities. She lives with her mum and brother and has a team of PAs that support her at home and out and about.
Marta does not use words to speak and relies on her mum and PAs who really understand her communication. She often experiences sensory overload and can hurt herself and other people if she is not supported in ways that work for her.
Marta becomes very unwell with stomach pains, and her GP thinks she has appendicitis. She goes into hospital with her mum for tests and they confirm that she needs to have her appendix removed.
Marta has a healthcare passport which has critical information for hospital staff about her communication and how she needs to be supported. It’s also agreed by the health team that it is important for Marta to be supported in hospital by one of her PAs or by her mum, as it is clear that the risk of infection is less than the risk of Marta hurting herself or someone else because she is distressed.
To reduce the risk of infection, the PA team agree that just one person, Anya, will take turns supporting Marta in hospital along with her mum. They work with the health team to agree use of PPE and follow hospital infection control procedures.
The operation takes place and after a few days, Marta is able to go home. Although she found the experience difficult, hospital staff, Anya and Marta’s mum felt the experience was the best it could have been.
The effect of Care Act easements on legal rights under the Care Act for advocacy support
Individuals’ rights to advocacy support are not affected by Care Act easements. Within the next update to the Care Act easements guidance, we will ensure that this is made clear.
Further information about Care Act advocacy can be found in chapter 7 of the Care and Support Statutory Guidance. Similarly, there’s information on page 54 of the Mental Health Act 1983: Code of Practice and Independent Mental Capacity Advocacy on page 178 of the Mental Capacity Act Code of Practice.
Easy read resources about advocacy can be found at the National Development Team for Inclusion’s website.
Developing a contingency plan
We recommend that everybody with a direct payment develops a contingency plan, or updates their existing plan, to ensure needs can continue to be met if care is at risk of breaking down because of COVID-19. It may be possible for a direct payment support organisation to support you in developing this plan if you do not already have one.
You should discuss and agree this plan with your LA or CCG where possible, and then use it when you think it is necessary. Things you may want to consider including within this plan are:
staffing: setting out possible options for different arrangements, for circumstances where those you employ cannot work in their usual way. You may want to consider longer shift patterns and less frequent handovers, for example. When doing this, you should consider any additional pressures being placed on the individual you employ
different care and support arrangements: in circumstances where parts of your care and support are unable to be delivered (such as attending exercise classes in the community), you should consider what other arrangements can temporarily be put in place (for example, the use of indoor exercise classes and the use of video calls)
different networks of support: you should consider who else can support you if they are willing and able (such as extended family and friends), to keep safe, and what information, advice or training they may need to do this
upskilling of existing staff: you should think about what possible additional training or support there is for existing staff. This does not necessarily have to be through face-to-face training – it could be through learning from other staff, or learning on the internet
emergency contact: in case your care is in danger of breaking down, an emergency contact at your LA or CCG should be provided who you can talk to
We have developed a template contingency plan at annex A that you may wish to use.
Personal protective equipment (PPE)
The eligibility of PAs to get PPE
If your PA does not live in the same accommodation as you, there are a number of circumstances in which it is recommended that they wear more PPE than normal. These situations are described below in the section on wearing the right PPE and apply even if you do not have COVID-19 symptoms. If your PA has a clinical need for PPE as outlined in those situations, they are eligible to receive this. Furthermore, if your PA normally receives PPE to support you, this must continue.
More detail on who should provide this PPE is set out below.
Using direct payments to buy PPE
If your direct payment contains funding to purchase PPE for your PA, you should continue to use that funding to purchase PPE.
If you or your PA cannot get PPE in this way, your direct payment is not set up to fund PPE, or different/additional PPE needed during the COVID-19 pandemic cannot be funded through your existing direct payment, you should contact your LA or CCG that provides your direct payment. They will help you to get the PPE you need.
Wearing the right PPE
The following information is for care that is taking place in your home and assumes your PA does not live with you permanently. If you’re receiving support in a different setting, there’s specific PPE guidance on the Public Health England website.
In addition to this, you should read the most recent guidance published by Public Health England on what PPE is appropriate for PAs to wear who live in separate accommodation to the person requiring care.
This guidance applies whether you have symptoms of COVID-19 or not. In short, the guidance sets out that:
when providing personal care which requires a PA to be in direct contact with you (for example, touching) or when within 2 metres of anyone who is coughing, the PA should use disposable gloves, a disposable plastic apron and a fluid-repellent face mask. Eye protection may be needed if there’s a risk of droplets from the individual reaching the PA’s eyes (for example, caring for someone who is repeatedly coughing or who may be vomiting)
new disposable gloves and plastic aprons must be used for each individual episode of care (for example, washing, directly helping take medication etc), whether the person has symptoms or not. Surgical and fluid-repellent face masks can be worn continuously for multiple episodes of care, providing the PA does not touch or remove the face mask in between each action. Eye protection can also be used continuously, dependent on a risk assessment. See the conditions in which this should be undertaken
when the PA’s care and support does not need them to touch you, but they need to be within 2 metres, gloves and an apron are not needed but a surgical mask is. For example, when your PA is removing medicines from their packaging, or preparing food
if you or any members of your household are in the ‘extremely clinically vulnerable’ category and have received a letter to ‘shield’, as a minimum, your PA needs single-use disposable plastic aprons, surgical mask and gloves. A fluid-repellent face mask is needed instead of a surgical mask, if direct contact is required. See more details on who should be shielding
Disposing of used PPE
It’s essential that PPE that has come into contact with someone with COVID-19 symptoms is stored securely within rubbish bags that can be thrown away. These bags should be placed into another bag, tied securely and kept away from other waste.
The bag should be put aside for at least 72 hours before being put in the usual household waste bin.
Waste that has not come into contact with anyone that has COVID-19 symptoms can be disposed of normally.
Using PPE safely
PPE is only effective if it’s used correctly. Public Health England has produced a number of resources that explain how PPE can be safely used to reduce the spread of infection. It is important that PAs take off PPE in the recommended order. This helps to prevent self-contamination. See the guidance on how to put on and take off PPE safely.
PPE is also only effective when combined with good hand hygiene (cleaning hands regularly and appropriately), covering your mouth when coughing or sneezing, avoiding touching your face with your hands and when following standard infection prevention and control precautions.
PPE for family members providing care and support
All unpaid carers and family members looking after others should continue to follow the general hygiene guidance provided by the government. This includes washing their hands and cleaning frequently used surfaces.
If family members who provide you with care and support live with you permanently, Public Health England does not recommend using more PPE than would normally be used. If the family member is not living in the same accommodation and their care and support requires PPE, they should be able to access and use this PPE.
The guidance on what PPE is appropriate to use in this case is the same as for PAs who live in separate accommodation, as outlined above.
Footwear covers are not a part of recommended PPE
Footwear covers have not been included as part of PPE guidance for PAs or home care organisations. You can help to reduce any potential transmission by increased cleaning of floors and surfaces and keeping your house properly ventilated by opening windows whenever safe and appropriate.
Safely using paper towels or hand towels
There is no requirement for paper towels rather than hand towels. Individual hand towels, specific for each PA, can be used and should be washed and replaced frequently. Good hand hygiene and the correct use of PPE will reduce the potential for contamination.
Where PAs are using paper towels after coming into contact with someone with COVID-19 symptoms, they can be disposed of in regular household waste, but should be double bagged. You should wait for 72 hours before removing the bag from your home and disposing it as normal.
Responsibility for paying for and securing PPE for PAs
Getting appropriate PPE is very important, and LAs and CCGs have overall responsibility to ensure that you get the PPE you need to stay safe and receive the care and support you need.
Your direct payment might already be set up for you to buy the PPE you need. If this is the case, and you can buy this locally, you should do this first.
If that is not possible, you should speak to your direct payment support organisation, who may be able to help you in getting the PPE you need locally.
If that is not possible, you should speak to your LA or CCG urgently, who will help you to get the PPE you need. You should do this in advance of any of your PPE stock running out so there is time for that PPE to be delivered to you.
If your direct payment is set up so you have the money and responsibility for getting it, but you cannot buy it locally, your LA or CCG will get this for you from a national line.
Safe infection control in households
When cleaning, the usual household products, such as detergents and bleach, should be used. These products are very effective at getting rid of viruses on surfaces. Frequently touched surfaces should be cleaned regularly.
Personal waste (for example, used tissues and other items soiled with bodily fluids) and disposable cleaning cloths should be stored securely within disposable rubbish bags. These bags should then be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin for disposal as normal.
Dirty laundry should not be shaken before washing; this minimises the possibility of dispersing the virus through the air. Items should then be washed following the manufacturer’s instructions. All dirty laundry can be washed in the same load.
If you do not have a washing machine, wait a further 72 hours after the 7-day isolation period (for individual isolation) or a 14-day isolation period (for households) has ended. The laundry can then be taken to a public launderette. Items heavily soiled with body fluids, such as vomit or diarrhoea, or items that cannot be washed, should be put in the bin with your consent.
Further guidance on laundry and waste disposal is available in the Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection.
Employment of individuals
You should keep a temporary record of the shift patterns of your PAs for 21 days. If NHS Test and Trace ask for this data, you should provide it to them. This could help contain clusters or outbreaks.
Keeping safe when PAs become sick or are unable to work
If your PA becomes sick or is unable to work, you or somebody on your behalf should try to organise different arrangements. This is why contingency plans are so important. For example, it may be that another PA is willing and able to take on further work to provide you with the care and support you need.
If other arrangements cannot be put in place, it will be necessary to implement your contingency plan. For example, where they are sufficiently trained to do so, friends or family members may be willing to step in and support you to receive the care and support you need. Local authorities and CCGs have been directed to adopt a flexible approach to how the care and support plan is delivered during this period, to ensure that appropriate care and support is possible.
In cases where arrangements cannot be put in place to enable you to receive the care and support you need, you should contact your LA or CCG immediately. They will support you in developing a temporary plan to ensure your needs are met, while your PA is recovering. This might include a short-term package of care in emergencies to ensure you receive the care and support you need. You may wish to also speak to your insurance company, who can offer advice about how you can or should pay your PAs.
If your PA is concerned that they may have COVID-19 they should use the NHS 111 coronavirus service. If they need to self-isolate at home, they should not visit and care for you or provide support until it is safe to do so.
They should also follow the guidance on home care provision.
Example scenario 6
Tahmina employs a PA, Rebecca, through her direct payment to help her with some daily tasks. One morning, Tahmina receives a call from Rebecca, who informs her that a member of their household has begun to display symptoms of COVID-19. After consulting advice on GOV.UK, Tahmina and Rebecca agree that Rebecca cannot provide care until she is fully recovered.
Tahmina also receives support from another PA, Stuart, for a few days each week. Stuart is familiar with Tahmina’s needs and care plan, although he is not Tahmina’s main PA. Tahmina contacts Stuart to ask if he is able to increase the number of hours he works for her. Stuart says he is able to do this on a short-term basis.
Tahmina applies for statutory sick pay for Rebecca, for the time she is off ill, while paying Stuart a full wage until Rebecca is able to return.
PAs self-isolating if they have been in close contact with somebody who has tested positive for COVID-19
Under the new test and trace system, anybody who has had a specific ‘close contact’ with somebody who tests positive for COVID-19 will be expected to isolate themselves for 14 days, or for 7 days from developing symptoms of COVID-19. Broadly, a ‘close contact’ is:
- spending 15 minutes or more within 2 metres of an infected person
- very close specified personal interaction for a shorter period of time
- someone who has lived within the same household during a period of potential risk transmission
If a PA has had close contact with somebody who has tested positive for COVID-19 (or who has symptoms of COVID-19 and is waiting to be tested) but was wearing appropriate PPE during this close contact, it is unlikely they will need to isolate. These cases will be escalated to the local public health team to advise on, but unless there are very specific circumstances around the contact, they will usually advise your PA that they can continue to work as normal.
If your PA has had close contact with somebody who has tested positive for COVID-19 (or who has symptoms of COVID-19 and is waiting to be tested) but was either not wearing PPE at the time, or there was a PPE breach, then they will normally need to isolate for 14 days, in line with advice. It is important to keep social distancing wherever possible.
Using direct payments to pay family carers or close friends if your PA is not available
During this time, short-term emergency changes may be needed. Families and close friends may be asked to provide support beyond any unpaid care and support they may already be willing and able to provide. They may be willing to provide additional support on a voluntary basis for a short period of time, for example, while your PA recovers from sickness.
If you feel it is necessary for family members to become your paid care and support workers on a permanent or longer-term basis, this needs to be discussed and agreed with the LA or CCG. Decisions are made on a case-by-case basis.
For short-term arrangements (in an emergency and where it’s time-critical) you can put a suitable package of care and support in place that enables you to keep safe.
If you think this may be necessary during the pandemic, you should include this within your contingency plan. When doing this, you should think about the following:
- normal employment and payroll processes will need to be followed, including agreeing hours and pay rates
- whether there is any additional training and assessment of competence required
- whether there are any additional costs involved if your existing PAs are entitled to ongoing pay
- if family members take on paid care and support work, whether this will impact on any benefits they receive
- family members are often already providing significant levels of care and support. You should consider any impact on your family members’ health and wellbeing, and whether any unreasonable strain is being put on them
- if the family member is also the direct payment recipient and the employer there can be a conflict of interest. In these instances, employment of the family member through an agency or third party may be a solution
- any impact it may have on relationships if the family member is also an employee
Example scenario 7
Charlize employs 2 PAs through her direct payment to help her with some daily tasks. Charlize’s primary PA provides support for most of the time, although her second PA provides support for a few days each week and when her primary PA is away.
When Charlize received a call from her primary PA saying she was unable to attend work because someone they lived with was displaying symptoms of COVID-19, Charlize arranged for her second PA to temporarily provide increased support.
One morning, Charlize receives a call from her second PA who has been providing additional support while her primary PA is away. Charlize’s second PA says she has developed symptoms of COVID-19 and is unable to work.
Charlize consults her contingency plan. It is likely this will only need using for a short period, as her primary PA is due to return to work soon. When Charlize created this plan in consultation with her direct payments support service, it was agreed that Charlize could ask her mum to provide temporary support in an emergency. Charlize’s mum is familiar with Charlize’s care plan and has been trained for this eventuality.
Charlize‘s LA agree that Charlize can pay her mum, as she is likely to lose earnings by providing additional support to Charlize. This means Charlize’s direct payment is temporarily increased. This arrangement continues for a short period before Charlize’s main PA returns to work.
By being a core part of Charlize’s contingency plan, temporarily employing her mother has ensured Charlize received the care she needed in an emergency, while ensuring all the consequences of employing a family member were carefully considered beforehand.
Example scenario 8
Janet lives with her parents and sister. Usually, Janet uses her direct payment to employ a team of 3 PAs who come in to support Janet during the day. Overnight, Janet’s family are on call if support is required.
Two of Janet’s PAs have caring responsibilities and are not able to have their children in school because of health conditions. They are therefore temporarily unable to provide Janet with the care required. Janet’s sister, who is familiar with Janet’s care and support plan, works in a bookshop which is currently closed as a result of COVID-19.
Given these circumstances, Janet has revised her plan. She was able to successfully register her PAs for the Coronavirus Job Retention Scheme, and employ her sister on a short-term basis to ensure her care and support needs were met.
Re-employing previous PAs already trained to support you, in emergency situations
If needed (for example, because of a PA illness) then you could get in touch with a previous PA, who may be able to provide temporary cover, and will be familiar with your needs. You should write this in your contingency plan.
Your support needs may have changed since they worked for you. You should consider whether there is any additional training and assessment of competence or training needed (such as peer learning or e-learning) to get them up to speed as quickly as possible.
PAs will not need to hold official documentation to show they’re doing essential work
Government guidance is clear that anybody is permitted to travel to and from work if it is not possible to work from home. There is not a special status for key workers in this respect. No documentation is therefore needed to prove travel to and from work is necessary.
Where the definition of key workers may be needed is regarding access to other provisions, such as care for children at local schools if they cannot be cared for at home. As key workers, PAs are eligible for this support.
If documentation is required for a reason like this you should provide a letter to your PA. See an example template.
Financial or employment support available to direct payment holders
You should continue to receive the amount that was agreed with you when developing your plan. There are a range of steps LAs and CCGs should take in relation to this. These can be found in the guidance for commissioners, people receiving direct payments and care providers.
The government have also implemented other policies to support direct payment holders. These include:
- providing Statutory Sick Pay (SSP) from day one for people with COVID-19 related illness (including for those employed via a direct payment)
- bringing forward legislation to allow small and medium-sized businesses to reclaim SSP paid for sickness absence due to COVID-19
- deploying additional volunteers to support people at home
The Coronavirus Job Retention Scheme
DHSC has published some specific guidance with practical examples on the use of the Coronavirus Job Retention Scheme: people receiving direct payments.
How PAs will be affected by the Coronavirus Job Retention scheme
In general, the government expects that the Coronavirus Job Retention Scheme will not be used by many direct payment holders. This is because most public sector employees, like PAs, are continuing to provide essential public services or contribute to the response to the coronavirus outbreak. The government consider PAs to be an essential worker who provide vital care and support, and as such, use of this scheme should be minimal.
Nonetheless, government recognise there will be certain circumstances where it would be appropriate for a direct payment holder to furlough somebody they employ. For example, if your PA has been advised to shield through a letter from the NHS or has certain caring responsibilities. The specific guidance mentioned above provides detail and practical examples on this.
Points to consider when thinking about using the Coronavirus Job Retention Scheme
When making a decision about what’s best for you and your care arrangements, you may want to think about the following points. This is not an exhaustive list:
If you decide to stop PAs from coming into your home, depending on their employment contract they may be entitled to full pay. They are not automatically entitled to be furloughed under the government’s Coronavirus Job Retention Scheme, as the work may still be available. This would impact on your ability to pay others, where necessary, to provide you with the care and support you need.
You will need to think about how to ensure you continue to receive the care and support you require. Family or friends may be willing to provide care on a voluntary basis – for example, for 4 weeks – but this often is not a long-term solution.
If family or friends are unable to provide care on a voluntary basis and require payment for this, this could be an added cost pressure to the budget and you might need more funding. This would need to be agreed with your LA or CCG and the necessary budget adjustments made if required. Please see the section of this document on employing family members for further information.
It may be helpful to discuss your concerns about your PAs coming into your home with your LA, CCG or support service. They can help you to think through how to put in place increased infection control measures and changes in the way that tasks are carried out in your home. This might help you feel sufficiently confident to allow your PAs to continue to support you.
You might want to ask your PAs to work differently. For example, you could ask your PA to provide different types of care and support, such as shopping or picking up your prescription if you have one.
In all circumstances it is advisable where possible that you speak with your LA or CCG before making any formal changes
The eligibility of self-employed PAs for the scheme
Self-employed PAs are not eligible for the scheme. Individuals who are self-employed who have been adversely affected by coronavirus, should check whether they are eligible to receive a grant through the Self-Employment Income Support Scheme. This is easy to use and will tell a PA whether they are eligible and how much they can claim very quickly.
Employing a PA furloughed by somebody else
PAs who are put on furlough by somebody else may be able to work for you if their contract allows this. This means you may be able to employ someone who has been furloughed by their current employer to provide care for you.
When making a decision on employment, there are a number of things that you should think about:
people who are furloughed will only be available for a limited period, before needing to return to their original employer. New arrangements will therefore need to be put in place once the employee returns to their previous employer
if the new employee is carrying out work usually provided by another PA, there must be work for them to return to, as per their contracted hours
the existing budget may need to be reviewed by your LA/CCG to ensure sufficient funds are available to pay PAs who have been asked not to work, as well as the new employee who may now be paid to provide care.
If the furloughed person is a family member, there are additional considerations. Please refer to the section about employing family members for more information.
Statutory sick pay (SSP) for PAs with COVID-19 like symptoms
SSP for PAs if they need to self-isolate
If your PA meets the eligibility criteria, for example if they earn an average of at least £120 per week, then they will be eligible to receive SSP if they need to self-isolate. They will be paid from day one rather than the fourth day of their illness. See more guidance for employers.
Fit notes from self-isolating PAs
Fit notes are not needed from PAs who are self-isolating. If your PA says they are self-isolating, they will not be able to go to their doctor and are being asked not to call NHS 111 unless they really need to. You do not need evidence from your PA to be able to claim SSP for them.
If they are self-isolating and then become sick, they should let you know (by telephone, not in person).
Claiming back SSP paid to self-isolating PAs
You will be able to be refunded for necessary SSP paid to self-isolating PAs. SSP will be paid out through payroll and claimed back via HMRC. If you use a payroll provider, they will deal with this for you. This refund will be for up to 2 weeks per employee. See the employer guide to sick pay.
If you use payroll software to run your payroll yourself, then you will be required to pay SSP to your PA from your direct payment, and reclaim this from HMRC.
Limits to number of times you can claim SSP on behalf of your PA
There’s no limit on how many times you can claim SSP on behalf of your PA.
Tests for PAs and how they can access them
The government considers PAs as essential workers and therefore applications for tests can be made on GOV.UK. Alternatively, you can refer your PA for a test yourself. This can be done through the employer referral portal.
The test is most effective in the first 3 days of infection (but can still be effective up to 5 days). This means that any PA who has COVID-19 related symptom should get tested as soon as possible. Tests should not be done after 5 days of infection, unless they are specifically told it is possible.
If your PA has COVID-19 symptoms but does not want to get tested
In these circumstances, your PA should follow government advice and self-isolate. As your PA has COVID-19 symptoms, under no circumstance should they continue to provide you with care and support until after the necessary quarantine period. See more information on self-isolating.
As the employee is considered unfit for work, they may be entitled to statutory sick pay (SSP) from day one of the absence. Please see the section on statutory sick pay for more information.
General eligibility for testing
Information on who is eligible for testing is available at Coronavirus (COVID-19): getting tested
Essential workers (including PAs, volunteers and unpaid carers) in England, Scotland or Northern Ireland can apply for priority testing through GOV.UK by following the guidance on testing for essential workers.
Individuals can also get tested through this route if they have symptoms of coronavirus and live with an essential worker. See a full list of essential workers.
These tests for essential workers are prioritised over the tests available for the wider public through the NHS.
In England, social care workers and residents in care homes are also eligible for testing, whether they have symptoms or not. See the guidance on testing for care home residents and workers.
All direct payment holders are eligible to self-refer for testing if they are displaying symptoms. A test can be requested on NHS.UK.
In some circumstances, direct payment holders without symptoms will also be tested to inform any clinical diagnosis. If this is the case, you will be told by your clinician who supports you.
Funding transport costs to access drive-through tests
There are no plans to fund transport costs. If your PA thinks this is required, they should discuss this with the CCG/LA who provided the direct payment.
If your PA is not able to travel to get a test, home tests delivered to the PA’s door are now available. Order a test.
Reviewing of budgets during the pandemic
Budgets will continue to be reviewed during the pandemic. LAs and CCGs will take a proportionate approach to reviewing how direct payments have been spent. Records should be kept as normal so they are available when the next review takes place.
If you are concerned that the amount allocated to you within your direct payment is not enough, or is too much, you should speak to your LA or CCG, who are required to ensure the funding you are given is appropriate to meet your assessed need.
Evidencing spending during the pandemic
As is normal practice, you should keep hold of any receipts or evidence that shows how the direct payment has been used. You should have them available when your next review with your LA or CCG takes place.
Support available if you pay for your own care
If you are using your own money to employ a PA you should follow the general guidance given here and in the direct payment guidance around contingency planning, and health and safety. You should also follow the domiciliary care guidance.
If you find yourself in a position where these arrangements are unable to support you due to the wider impact of COVID-19 and you have no alternative arrangements available to you, you should contact your LA to discuss alternative care and support arrangements.
Advice if your PA has suspected coronavirus and refuses to isolate
If your PA is showing symptoms of COVID-19, they should immediately self-isolate. Under no circumstances should anybody with symptoms continue to provide you with face-to-face care.
If they (or anybody else you meet) refuse to isolate, you should immediately speak to your LA or CCG, who should support you to enforce this.
You may also speak to your insurance company, who have legal advisers who can support you to resolve these issues.
ACAS also have a national helpline, who will respond and advise on issues like this. They can be contacted on 0300 123 1100.
If your PA is not practising social distancing in their personal life
As the employer, you should discuss this with your PA. You should keep a record of your discussion and what has been agreed between you both. If your PA continues to refuse to practise social distancing in line with government advice, it might be appropriate to take disciplinary action.
It is important that all involved in your care and support understand the importance of social distancing. There’s an increased risk on both you, and them, if they do not do this.
If your PA does not want to come to work because they cannot practise social distancing while providing care
You should speak with your PA about their concerns and explain to them what has been put in place to support them to support you safely, in line with guidance. You may want to discuss tasks that can be undertaken, where social distancing is possible.
However, there are some tasks where this will not be possible, for example if your PA is providing personal care. In these circumstances, it is important that your PA wears the required PPE and follows the additional infection control procedures that are in place. Doing this can help to reduce fears.
Support is also available to you from your LA, CCG or support organisation, to help you decide on the best course of action based on the circumstances.