CQC Quality Statements
Theme 1 – Working with People: Supporting people to live healthier lives
We Statement
We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.
What people expect
I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.
MANCHESTER SPECIFIC INFORMATION
CONTENTS
- 1. Introduction
- 2. Eligibility for Disability Related Expenditure
- 3. Financial Assessment
- 4. Factors to Consider when Charging
- 5. Reconsideration and Complaints
- 6. Further Reading
- Appendix 1: Examples of Disability Related Expenditure and Sources of Evidence
- Appendix 2: Norfolk Judgment
- Appendix 3: Summary of Disability Related Expenses
- Appendix 4: Specific Regulations
1. Introduction
Disability related expenditure (DRE) is the additional expense that a person incurs, specifically because they are disabled or have health problems. The local authority must take eligible expenditure into account in financial assessments to make sure that people who pay towards their care and support have enough money to live on (see Charging and Financial Assessment chapter).
Please note: Where a local authority decides to make a charge, it must comply with the provisions in the Care and Support (Charging and Assessment of Resources) Regulations 2014 (SI 2014/2672) (Regulations) and the statutory guidance Chapter 8 and Annexes B and C.
A local authority cannot impose charges which would cause a person’s remaining income (after the charge) to fall below a certain amount specified in the Regulations, Minimum Income Guarantee (MIG) (section 14(7), Care Act 2014).
Regulations 6 and 7 specify the personal expenses allowance for residents or temporary residents provided with accommodation in a care home, and the MIG amount for other adults and carers provided with care and support, or support. The personal expenses allowance is currently set at £25.65 for each week.
Examples of DRE include additional costs for heating if someone feels the cold because of their impairment and needs extra heating to keep warm and additional laundry costs for someone who is incontinent. See Appendix 1: Disability Related Expenditures and Sources of Evidence for further information.
2. Eligibility for Disability Related Expenditure
To qualify for a DRE the citizen must be in receipt of the care component of Disability Living Allowance, Personal Independence Payment (Care) or Attendance Allowance.
Their needs assessment and support plan should also identify disabilities or medical conditions which demonstrate their need for DRE.
The local authority should assess the adult’s DRE as part of their financial assessment.
3. Financial Assessment
At the financial assessment meeting, the adult or their carer will need to provide the local staff member (usually a social worker or financial assessment officer) with the following information:
- the costs they have due to being disabled or having a health condition; and
- how much these costs are.
The adult will also need to provide receipts or any other evidence of these costs (see Appendix 1: Examples of Disability Related Expenditure and Sources of Evidence).
In the majority of cases the case management officer financially assesses the individual based on:
- financial information provided by the Department for Work and Pensions;
- (where available) rent and Council Tax outgoings identified by Revenues and Benefits.
This provides the citizen with a provisional assessed contribution to which DREs and further housing related outgoings can be applied.
The notification letter includes an explanation of:
- how the assessment has been carried out;
- what the charge will be;
- how it should be paid.
Where the assessed contribution has been revised from a previous assessed amount, the letter will also detail the reason for the revision.
When notifying the citizen, the case management officer provides the individual with a DRE form to complete and return with supporting evidence. The form specifies the evidence required
When considering DRE, the local authority will:
- look at the information provided, including the receipts and any other evidence;
- check to see if the costs provided relate to their care needs as specified in their care and support plan (see Support Planning chapter);
- check to see if any income the citizen receives already covers these costs.
The citizen should return the form and evidence as soon as possible. Where eligible, any allowances made may be applied from the date of the relevant assessment or, if appropriate, a later date.
If the citizen wishes to claim DRE, the case management officer will review the assessment, request approval from the social worker (through Liquid Logic) and let the person know the outcome of the assessment in writing. The letter will include an explanation of how each item claimed has been treated. In some cases further evidence may be required from the citizen or clarification regarding the need for the expenditure.
The DREs are subject to periodic review, however if the individual ceases to incur a DRE expense, their expenditure amount changes or they wish to have a new DRE considered, they should contact the Case Management Team straightaway.
4. Factors to Consider when Charging
The MIG amount in relation to adults who have needs for care and support or a carer who has needs for support, is the total of the amounts set out in regulation 7(1).
Section 17 of the Care Act 2014 states that where a local authority decides to exercise the power to charge for care and support, it must assess:
- the level of the adult’s financial resources;
- the amount that the adult would be likely to be able to pay towards the cost of meeting the needs for care and support.
Apart from the limit set by the MIG, the regulations impose other constraints on a local authority’s power to charge services. When carrying out the financial assessment of resources under the regulations, in order to set the level of charge a local authority is prohibited from taking into account various items, including:
- earnings from employment or self-employment;
- housing-related costs;
- the mobility element of PIP (but not the daily living element of PIP);
- any disability related expenditure paid for with disability benefits.
Otherwise, regulation 15(2) gives the local authority the discretion to decide what it will or will not take into account when carrying out the financial assessment in order to decide how much to charge a person for care and support.
See Appendix 4: Specific Regulations for further information.
5. Reconsideration and Complaints
If the citizen or their carer / representative does not agree with the assessed contribution or the treatment of a DRE, they can ask for reconsideration.
The Case Management Team will review the citizen’s financial assessment to ensure that the calculation is accurate.
If the outcome of the review is that the correct amount has been calculated, but the citizen or their representative is still not satisfied with the decision, they can ask for the Case Management Team Leader to reconsider their case.
If the citizen or their representative are not satisfied with the panel’s decision, they can make a complaint (see Complaints chapter).
6. Further Reading
6.1 Relevant chapters
Charging and Financial Assessment
Appendix 1: Examples of Disability Related Expenditure and Sources of Evidence
| Private Personal Care | The citizen’s assessor or social worker will assess whether this help is needed, and is not already included in the citizen’s Individual Budget. Confirmation from the assessor/social worker is required before the actual costs can be allowed. | ||||||
| Private Domestic Help | The citizen’s assessor or social worker will need to assess whether this help is needed, and is not already included in the citizen’s Individual Budget. Confirmation from the assessor/social worker is required before the actual costs can be allowed. Payments to immediate family members cannot be taken into account. | ||||||
| Holidays | The citizen’s assessor or social worker will need to assess whether this help is needed, and is not already included in the citizen’s individual budget. Confirmation from the assessor / social worker is required before the actual costs can be allowed. | ||||||
| Laundry – includes washing powder, detergents etc. | Additional laundry costs as a result of a citizen’s disability. The citizen’s assessor or social worker will need to assess whether this help is needed, and is not already included in the citizen’s individual budget. Confirmation from the assessor / social worker is required before the actual costs can be allowed. | ||||||
| Clothing
|
Additional clothing costs due to the purchase of specially made or adapted items for a citizen’s disability. Any expenditure allowance made will be discretionary. | ||||||
| Diet and Food
|
The amount taken into account for the cost of special dietary needs will be discretionary as they may not exceed normal expenditure. We may use the Government’s Living Costs & Food Survey to assess excess expenditure on specialist food items caused by illness or disability. | ||||||
| Prescription Charges | Allow cost of annual prepayment certificate divided by 52, or actual cost of prescriptions whichever is the lower. | ||||||
| Medical Expenses (non-prescription items e.g. creams, supplements) | Expenditure for non-prescription items which may be used for skin conditions, etc, is allowed. Actual expenditure over the current prescription charge. | ||||||
| Disability Related Equipment |
No allowance will be made for disability related equipment if it has already been provided free of charge by the local health authority, or the purchase has been supported by grant funding. This includes the purchase, maintenance or repair of such equipment. We will not allow expenditure that we consider to be a lifestyle choice. The care assessor/ occupational therapist will need to identify such equipment in the support plan. Examples of disability related equipment include: wheelchairs, power beds, hoists, reclining/lifting chairs, and stairlifts. |
||||||
| Chiropody | Not normally allowed unless there are special circumstances as this should be provided under the NHS. NHS chiropodist allows between 2-3 visits per year. If paying privately allow up to 3 visits per year if there are exceptional circumstances preventing the citizen from using the NHS e.g. a long waiting list. | ||||||
| Gardening | The amount taken into account is based on the cost of maintaining the citizen’s garden to a basic standard, providing the need for garden maintenance is due to the citizen’s disability and not a lifestyle choice. | ||||||
| Transport and Travel | Costs should be met by benefits such as DLA/PIP mobility component and travel concessions. The need for specialist transport should be evidenced in a citizen’s assessment and support plan. | ||||||
| Communication Needs | The cost of a telephone or internet access is regarded as an everyday living expense and therefore allowances will not be made unless it can be proved that additional costs have been incurred as a result of a citizen’s disability. | ||||||
| Community Alarm Charges | The cost of the community alarm service received; there are currently two rates in Manchester:
|
Household Fuel costs
Household Fuel Costs can be taken into account if evidenced. Rates based on the region’s average heating costs and revised annually based on the latest RPI Fuel Index figures published by the National Statistics Office.
| Occupancy/Type of Property |
| Single person – Flat / Terrace |
| Couple – Flat / Terrace |
| Single person – Semi Detached |
| Couple – Semi Detached |
| Single – Detached |
| Couple – Detached |
Appendix 2: Norfolk Judgment
Case law
R (on the application of SH) v Norfolk County Council and Secretary of State social Care [2020] EWHC 3436 (Admin) (known as the Norfolk Judgment).
The High Court in R (SH) v Norfolk CCC held that a local authority’s decision to change the basis on which it calculated its charges to disabled people in respect of their care and support needs by reducing the council’s minimum income guarantee (MIG) and taking into account the previously disregarded personal independence payment (PIP) daily living component, discriminated against severely disabled people, contrary to Article 14 of the ECHR when read with Article 1 of the first Protocol to the ECHR.
The issue of charges for non-residential services that came before the court.
- It was found that the proportion of income that was paid by a person with a severe disability in assessed charges was greater than the proportion paid by a person who was not severely disabled.
- That amounted to indirect discrimination contrary to Article 14 of the European Convention on Human Rights which the council was not able to justify.
As a result of the case, campaigning groups have found that some local authorities are operating unlawful charging policies, and advise that they must consider the ruling and examine whether their policies could be discriminatory. This is to ensure they are fulfilling their Public Sector Equality Duty and that they are not breaching the Human Rights Act. While other councils’ policies will not be automatically unlawful merely as a result of the decision in SH’s case, if the policies are considered to be discriminatory it is important to take steps to correct this.
2.1 Norfolk judgment facts
The Council charged SH for care, on a means-tested basis, as is permissible under section 14 of the Care Act 2014; Section 14(7) says a local authority cannot levy charges which would cause SH’s income to fall below a certain amount specified in the regulations – the MIG.
A local authority has a discretion under Regulation 15(2) of the Care and Support (Charging and Assessment of Resources) Regulations 2014 about what it will or will not take into account when means testing the person to be charged for council services.
Norfolk County Council had changed the basis on which it calculated charges made to SH for its services. The Council exercised its discretion to take into account SH’s enhanced benefits (apart from the mobility component of PIP which, by law, the Council cannot take into account) and reduced her MIG.
This change was set to increase SH’s charges. Originally, the charge to SH was £16.88 per week but this was increased to £50.53 per week once the new charge was implemented. These charges were to come out of SH’s income from state benefits and was a significant increase. This charging policy is what was challenged by SH.
2.2 Norfolk Judgment issues and findings
SH was granted permission to apply for judicial review on the grounds that the charging policy discriminated against severely disabled people contrary to Article 14 of the European Convention on Human Rights read with Article 1 of the First Protocol to the European Convention on Human Rights (A1P1):
- Firstly, the circumstances must fall into the realm of a Convention right. Finding: The Judge found that SH’s income from benefits was ‘property’ and therefore fell within the ambit of A1P1, which protects against being deprived of possessions ‘except in the public interest and subject to the conditions provided for by law.”
- Secondly, there must have been a difference in treatment on the ground of one of the characteristics listed in Article 14 or ‘other status’. Finding: The Judge concluded that SH was in the category of ‘severely disabled’ and this had Article 14 status.
- Thirdly, there must have been a difference of treatment between two people who are in an analogous situation. Here, the two groups of people were the severely disabled and others receiving council services covered by the charging policy. Finding: the Judge found that the former class ‘severely disabled’ (such as SH) and later class other people receiving council services were in an similar position. Their treatment was different because, under the charging policy, a higher proportion of SH’s earnings in the former class would be assessed similarly to the later class and as a result she would be charged proportionately more than the later class would be.
- Fourthly, objective justification for the different treatment must be lacking. Finding: The Judge found that the local authority had not focused its attention on the differential impact, nor considered the alternative approach suggested in the Care Act Guidance (paragraph 8.47) of setting a maximum percentage of disposable income (over and above the MIG) which may be taken into account in charges. Although the changes were approached conscientiously by the local authority (e.g. through a slow phasing in of the increased charges) the outcome of the discriminatory impact on the severely disabled was overlooked. The Judge found that the differential impact on the severely disabled was without reasonable justification and therefore breached Article 14.
Appendix 3: Summary of Disability Related Expenses
DREs are the costs associated with having a disability or medical condition.
The local authority may take into account and reasonable costs of help or support a person needs to live independently.
This cost must also have been identified in the person’s care and support plan.
Allowances for disability-related expenditure will only be made where those costs are:
- met entirely by the person;
- specifically relate to the disability in question;
- supported by documentary evidence – receipts dating back up to six months (dependant on the local authority’s policy.)
- exceed ‘normal’ costs of living expenses (that is, what an adult without the disability would reasonably be expected to spend.)
If the cumulative amount of any disability-related expenditure claimed by a new or existing customer of Adult Social Care Services is in excess of a certain amount (generally £25.00 per week) then the financial approval of the local operations manager is required.
Additional factors considered in relation to a claim for these DREs are:
- Will the person be receiving a personal budget that will incorporate some of the identified disability-related expenditure?
- Should any of the additional disability-related costs be paid for by the NHS, such as chiropody, physiotherapy, incontinence pads, and transport to attend hospital appointments?
- Are any items being provided through, or facilitated by, other directorates within the Council?
Appendix 4: Specific Regulations
Earnings from employment or self-employment (regulation 14).
Housing-related costs (regulation 15(1) and paragraph 1 of Schedule 1).
The mobility element of PIP (but not the daily living element of PIP) (regulation 15(1) and paragraph 8 of Schedule 1).
Any disability related expenditure paid for with disability benefits (regulation 15(1) and paragraph 4 of Schedule 1).
