Factsheet number: 7.9



Last Updated: 28 July 2020

Introduction

Receiving a direct payment from your local Council or the NHS allows you to purchase support to meet your health and/ or social care needs in a variety of different ways. Many people choose to recruit and manage their own Personal Assistants (PAs) however you may prefer to use the services of a care agency to provide your care instead.

Even if you employ your own PAs, and if your direct payment budget will allow, you may wish to use an agency service to supply temporary staff to cover at times of holiday or absence, or in an emergency where your regular PAs are unavailable. If you do this, please ensure it is agreed by the Council or the NHS.

Some people choose to use an agency service to achieve some of their outcomes, along with employing their own PA for certain other tasks. This factsheet is intended to give some advice about what you need to think about when choosing and engaging agency services.

Contents

1. Finding the right agency for you

1.1 Care Guides

1.2 Making the right decision

2. Checking quality standards

2.1 The Care Quality Commission

3. Introduction agencies and self-employed staff

3.1 Checking self-employment status

4. Paying the agency

Finding the right agency for you

You will need to find out which agencies are providing a service in your local area. Independent Lives can supply you with a list of agencies operating in your area but cannot recommend a particular service.

1.1 Care Guides

Depending on your area, the best place to start is a Care Guide which is jointly produced by a local council and usually a user forum to provide information and advice about care and support services for adults. These can be found on the Council website.

1.2 Making the right decision

You will need to decide which agencies to talk to and then discuss with each agency how they can help you achieve the agreed outcomes in your support/personal plan. This will mean negotiating when and how you want their service delivered and how much you will pay depending on what is affordable within your budget and represents good value for money.

There are many registered agencies to choose from, as the customer, you are free to clearly express your preferences for certain staff. Continuity of care in terms of having the same agency staff is very important to some customers and you may find it difficult to establish a good relationship with a changing staff team. If you think this is likely to be the case you should explain this to the agency before you engage them to provide your care, to establish if you will have the choice over which members of staff will work with you on a regular basis.

2. Checking quality standards

It is important to ensure that the care agency you choose can meet your needs. This means not only checking out what they can provide, but also ensuring that the care they provide is of a sufficiently high and consistent quality.

2.1 The Care Quality Commission

As part of the Government’s initiative to improve care standards, all care agencies and providers of residential respite care must be registered with the Care Quality Commission (CQC), who are the independent regulators of health and adult social care in England. CQC register (and therefore license) providers of care services once they can show that they meet essential standards of quality and safety. CQC and then monitor them to make sure they continue to meet these standards. You should only use agencies who are registered with CQC and who produce a Certificate of Registration upon request.

The Care directory search tool on the Care Quality Commission’s website www.cqc.org.uk lets you search by postcode, town, and geographical area for social and health care services.

As of 1st October 2010 (and updated in October 2014) every health and adult social care service in England is legally responsible for making sure it meets new fundamental standards of quality and safety. The fundamental standards are:

  1. You must have care or treatment that is tailored to you and meets your needs and preferences.
  2. You must be treated with dignity and respect at all times while you're receiving care and treatment.
  3. You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you.
  4. You must not be given unsafe care or treatment or be put at risk of harm that could be avoided.
  5. You must not suffer any form of abuse or improper treatment while receiving care.
  6. The places where you receive care and treatment and the equipment used in it must be clean, suitable and looked after properly.
  7. You must be able to complain about your care and treatment.
  8. The provider of your care must have plans that ensure they can meet these standards.
  9. The provider of your care must have enough suitably qualified, competent, and experienced staff to make sure they can meet these standards.
  10. The provider of your care must only employ people who can provide care and treatment appropriate to their role. They must have strong recruitment procedures in place and carry out relevant checks such as on applicants' criminal records and work history.
  11. The provider of your care must be open and transparent with you about your care and treatment.
  12. The provider of your care must display their CQC rating in a place where you can see it. They must also include this information on their website and make our latest report on their service available to you.

To read more about each of these standards look here: http://www.cqc.org.uk/content/fundamental-standards

3. Introduction agencies and self-employed staff

Care agencies that employ their own staff are responsible for all aspects of their staff's pay and employment. However, some agencies act simply as ‘Introduction Agencies' and will charge you a fee for introducing you to new carers. The workers they provide may class themselves as self-employed, in which case you will have to pay the carer directly rather than paying the agency. You should always ask the agency what the employment status of their workers is and you should always insist on a written contract for services from the agency.

3.1 Checking self-employment status

If you do take on a self-employed PA, you must ensure that they are genuinely self-employed for income tax and national insurance purposes. You will need to get formal confirmation of their self-employed status from HMRC in order to ensure that you are protected from future financial penalties. You should keep a record of any information you used to make your decision about your PA’s employment status.

There are two ways of doing this.

(a) Employment Status Indicator

HMRC’s Employment Status Indicator (ESI) tool enables you to obtain an indication of the employment status of your PA for tax, National Insurance Contributions (NICs) or VAT purposes.

To access this tool visit http://www.hmrc.gov.uk/calcs/esi.htm

This tool is only an indicator, and the result is not a legally binding indication of your PA’s employment status. A further way of verifying your PA’s employment status is explained below.

(b) Employment Status Customer Service Unit

You can also request a written opinion on a PA’s employment status by contacting HMRC’s Status Customer Service Team provided you accurately explain all the relevant facts to them, HMRC will accept the team's opinion as legally binding.

Phone: 0300 123 2326 open 8.30 am to 4.00 pm, Monday to Friday.

Write to:    HM Revenue and Customs

                     Employment Status Customer Service Unit

                     SO733

                     Newcastle Upon Tyne

                     NE98 1ZZ

For more information on self-employment please see self-employment – factsheet 7.2.

Self-Employment – factsheet 7.2

4. Paying the agency

The agency you use will invoice you on a regular basis (weekly or monthly) for the services you receive from them. You negotiate the cost of the services you need and how often.

You will need to pay the agency invoices by cheque or direct transfer from your Direct Payments bank account or prepaid card. Please note that registered care agencies are not allowed to charge VAT on their invoices to you.