The National Health Service (Direct Payments) Regulations 2010

Monitoring and review of direct payments

17.—(1) The Secretary of State or an after-care PCT must monitor—

(a) the making of direct payments to or in respect of a patient; and

(b) the health conditions of the patient in respect of which direct payments are made.

(2) The Secretary of State or an after-care PCT must review the making of direct payments to or in respect of the patient at appropriate intervals and—

(a) at least once within the first three months of the direct payments being made; and

(b) subsequently, at intervals not exceeding twelve months.

(3) Where the Secretary of State or an after-care PCT is notified, or becomes aware, that the state of health of the patient has changed significantly, the Secretary of State or an after-care PCT must consider whether a review is appropriate.

(4) Where the Secretary of State or an after-care PCT becomes aware that direct payments have not been sufficient to secure the services specified in a care plan, the Secretary of State or an after-care PCT must carry out a review.

(5) When carrying out a review the Secretary of State or an after-care PCT must—

(a) review the care plan to establish whether it continues to provide appropriately for the health needs of the patient;

(b) consider whether the direct payments have been used effectively;

(c) consider whether the amount of the direct payments paid to or in respect of the patient is sufficient to provide for the full cost of each of the services specified in the care plan; and

(d) consider whether the patient, representative or nominee has complied with the obligations imposed on them by or under regulation 14.

(6) When carrying out a review the Secretary of State or an after-care PCT may—

(a) re-assess the health needs of the patient for services to be secured by way of direct payments;

(b) consult any of the persons mentioned in regulation 10(2)(a) or (3)(a) to (c) or, where relevant, (e);

(c) review receipts, bank statements or other information relating to the use of the direct payments;

(d) consider whether the direct payments have been effectively managed, including whether any provider of services secured by means of the direct payments—

(i) if carrying on a regulated activity, is registered as a service provider in respect of that activity with the Care Quality Commission,

(ii) has complied with any obligation that the provider has to be registered as a member of a profession regulated by a body mentioned in section 25(3) of the 2002 Act, or

(iii) operates under insurance or indemnity cover which is proportionate to the risks involved in providing the service and otherwise appropriate in relation to the services provided to the patient.

(7) If a patient, representative or nominee requests the Secretary of State or after-care PCT to review the making of direct payments—

(a) the Secretary of State or after-care PCT must decide whether to carry out a review, taking into account relevant local practices and circumstances; and

(b) if the Secretary of State or after-care PCT decides to carry out a review, they must carry out the review in accordance with this regulation.

(8) Following a review, the Secretary of State or after-care PCT may, having regard to the purposes of the care plan and the consultations and enquiries under regulation 10—

(a) amend the care plan;

(b) substitute the patient for the nominee or representative of the patient, or substitute a representative or nominee for the patient, as the person to whom the direct payments are made;

(c) increase, maintain or reduce the amount of the direct payments;

(d) impose on the patient, representative or nominee either or both of the following conditions in connection with the making of direct payments, that—

(i) the recipient, whether the patient, their representative or their nominee, must not secure a service from a particular person, or

(ii) the patient, their representative or their nominee must provide information that the Secretary of State or after-care PCT considers necessary other than as described at regulations 10(2)(b), (4)(a) or (6)(c), or 14(5), (8) or (9); or

(e) take other action that the Secretary of State or after-care PCT considers appropriate.

(9) Where, following a review, the Secretary of State or after-care PCT decides to reduce the amount of or stop making the direct payments the Secretary of State or after-care PCT must give reasonable notice in writing to the patient and any representative or nominee, stating the reasons for the decision.

(10) On receipt of a notice under paragraph (9), a patient, representative or nominee may require the Secretary of State or after-care PCT to undertake a further review and may provide evidence or relevant information for the Secretary of State or after-care PCT to consider as part of that review.

(11) The Secretary of State or after-care PCT must give written notice to the patient and any representative or nominee of the decision on any further review, stating the reasons for the decision.

(12) The Secretary of State or after-care PCT may not be required to undertake more than one further review following a decision under paragraph (9).