Social workers confused over capacity to consent to direct payments, study finds

Practitioners sometimes confuse the lack of capacity to manage a direct payment with an inability to consent to it, a new study has found.

Research by Bristol University and the Mental Health Foundation funded by the School for Social Care Research found that practitioners sometimes believed people who could not manage their money were also unable to consent to the payments, even though the money could be managed by a nominated “suitable person”, often a friend, relative or carer.

But Toby Williamson, head of development and later life at the Mental Health Foundation, said the Department of Health’s guidance and the law on direct payments for people who lack capacity were confusing. The guidance says assessments must consider the ability to consent to the payments separately from the capacity to manage them but in reality, Williamson said, many people would not think about the issues separately.

“In my view it is a flaw in the guidance rather than practitioners doing something fundamentally wrong,” he said.

He said the outcomes for the people in the study whose direct payments were managed by a “suitable person” were good but the process of assessment was “complicated and lacking in clarity for everyone involved”. He added: “Practitioners were mindful of what they were doing but struggled to explain the process to the people involved”.

The Mental Health Foundation has published a practitioner guide and a smart phone app to help practitioners work through the process of considering direct payments for people who lack capacity.

The research involved interviews with 67 practitioners and 18 “suitable people” across six local authorities in England.