(8) A reference to the provision of nursing care by a registered nurse is a reference
to the provision by a registered nurse of a service involving—

(a) the provision of care, or

(b) the planning, supervision or delegation of the provision of care,

5other than a service which, having regard to its nature and the circumstances
in which it is provided, does not need to be provided by a registered nurse.

(9) Where, in a case within subsection (4), the National Health Service
Commissioning Board has responsibility for arranging for the provision of the
nursing care, the reference in paragraph (a) of that subsection to a clinical
10commissioning group is to be read as a reference to the Board.

(10) For the purposes of its application in relation to the duty in section 2(1)
(preventing needs for care and support), this section is to be read as if
references to meeting needs under sections 18 to 20 were references to
performing the duty under section 2(1).

23 15Exception for provision of housing etc.

(1) A local authority may not meet needs under sections 18 to 20 by doing
anything which it or another local authority is required to do under—

(a) the Housing Act 1996, or

(b) any other enactment specified in regulations.

(2) 20“Another local authority” includes a district council for an area in England for
which there is also a county council.

(3) For the purposes of its application in relation to the duty in section 2(1)
(preventing needs for care and support), this section is to be read as if, in
subsection (1), for “meet needs under sections 18 to 20” there were substituted
25“perform the duty under section 2(1)”.

Next steps after assessments

24 The steps for the local authority to take

(1) Where a local authority is required to meet needs under section 18 or 20(1), or
decides to do so under section 19(1) or (2) or 20(6), it must—

(a) 30prepare a care and support plan or a support plan for the adult
concerned,

(b) tell the adult which (if any) of the needs that it is going to meet may be
met by direct payments, and

(c) help the adult with deciding how to have the needs met.

(2) 35Where a local authority has carried out a needs or carer’s assessment but is not
required to meet needs under section 18 or 20(1), and does not decide to do so
under section 19(1) or (2) or 20(6), it must give the adult concerned—

(a) its written reasons for not meeting the needs, and

(b) (unless it has already done so under section 13(5)) advice and
40information about—

(i) what can be done to meet or reduce the needs;

(ii) what can be done to prevent or delay the development by the
adult concerned of needs for care and support or of needs for
support in the future.

(3) Where a local authority would be required to meet an adult’s needs for care
and support under section 18 were it not for the fact that the adult does not
want the authority to do so, the authority must nonetheless prepare an
independent personal budget for the adult (see section 28).

25 5Care and support plan, support plan

(1) A care and support plan or, in the case of a carer, a support plan is a document
prepared by a local authority which—

(a) specifies the needs identified by the needs assessment or carer’s
assessment,

(b) 10specifies whether, and if so to what extent, the needs meet the eligibility
criteria,

(c) specifies the needs that the local authority is going to meet and how it
is going to meet them,

(d) specifies to which of the matters referred to in section 9(4) the provision
15of care and support could be relevant or to which of the matters
referred to in section 10(5) and (6) the provision of support could be
relevant,

(e) includes the personal budget for the adult concerned (see section 26),
and

(f) 20includes advice and information about—

(i) what can be done to meet or reduce the needs in question;

(ii) what can be done to prevent or delay the development of needs
for care and support or of needs for support in the future.

(2) Where some or all of the needs are to be met by making direct payments, the
25plan must also specify—

(a) the needs which are to be so met, and

(b) the amount and frequency of the direct payments.

(3) In preparing a care and support plan, the local authority must involve—

(a) the adult for whom it is being prepared,

(b) 30any carer that the adult has, and

(c) any person whom the adult asks the authority to involve or, where the
adult lacks capacity to ask the authority to do that, any person who
appears to the authority to be interested in the adult’s welfare.

(4) In preparing a support plan, the local authority must involve—

(a) 35the carer for whom it is being prepared,

(b) the adult needing care, if the carer asks the authority to do so, and

(c) any other person whom the carer asks the authority to involve.

(5) In performing the duty under subsection (3)(a) or (4)(a), the local authority
must take all reasonable steps to reach agreement with the adult or carer for
40whom the plan is being prepared about how the authority should meet the
needs in question.

(6) In seeking to ensure that the plan is proportionate to the needs to be met, the
local authority must have regard in particular—

(a) in the case of a care and support plan, to the matters referred to in
45section 9(4);

(b) in the case of a support plan, to the matters referred to in section 10(5)
and (6).

(7) The local authority may authorise a person (including the person for whom the
plan is to be prepared) to prepare the plan jointly with the authority.

(8) The local authority may do things to facilitate the preparation of the plan in a
case within subsection (7); it may, for example, provide a person authorised
5under that subsection with—

(a) in the case of a care and support plan, information about the adult for
whom the plan is being prepared;

(b) in the case of a support plan, information about the carer and the adult
needing care;

(c) 10in either case, whatever resources, or access to whatever facilities, the
authority thinks are required to prepare the plan.

(9) The local authority must give a copy of a care and support plan to—

(a) the adult for whom it has been prepared,

(b) any carer that the adult has, if the adult asks the authority to do so, and

(c) 15any other person to whom the adult asks the authority to give a copy.

(10) The local authority must give a copy of a support plan to—

(a) the carer for whom it has been prepared,

(b) the adult needing care, if the carer asks the authority to do so, and

(c) any other person to whom the carer asks the authority to give a copy.

(11) 20Where an adult with needs for care and support has a carer, the local authority
may combine a care and support plan with a support plan if the adult needing
care and the carer agree.

(12) Regulations may specify cases or circumstances in which such of paragraphs
(a) to (f) of subsection (1) and paragraphs (a) and (b) of subsection (2) as are
25specified do not apply.

26 Personal budget

(1) A personal budget for an adult is a statement which specifies—

(a) the cost to the local authority of meeting those of the adult’s needs
which it is required or decides to meet as mentioned in section 24(1),

(b) 30the amount which, on the basis of the financial assessment, the adult
must pay towards that cost, and

(c) if on that basis the local authority must itself pay towards that cost, the
amount which it must pay.

(2) In the case of an adult with needs for care and support which the local
35authority is required to meet under section 18, the personal budget must also
specify—

(a) the cost to the local authority of meeting the adult’s needs under that
section, and

(b) where that cost includes daily living costs—

(i) 40the amount attributable to those daily living costs, and

(ii) the balance of the cost referred to in paragraph (a).

(3) A personal budget for an adult may also specify other amounts of public
money that are available in the adult’s case including, for example, amounts
available for spending on matters relating to housing, health care or welfare.

27 Review of care and support plan or of support plan

(1) A local authority must—

(a) keep under review generally care and support plans, and support
plans, that it has prepared, and

(b) 5on a reasonable request by or on behalf of the adult to whom a care and
support plan relates or the carer to whom a support plan relates, review
the plan.

(2) A local authority may revise a care and support plan; and in deciding whether
or how to do so, it—

(a) 10must have regard in particular to the matters referred to in section 9(4)
(and specified in the plan under section 25(1)(d)), and

(b) must involve—

(i) the adult to whom the plan relates,

(ii) any carer that the adult has, and

(iii) 15any person whom the adult asks the authority to involve or,
where the adult lacks capacity to ask the authority to do that,
any person who appears to the authority to be interested in the
adult’s welfare.

(3) A local authority may revise a support plan; and in deciding whether or how
20to do so, it—

(a) must have regard in particular to the matters referred to in section 10(5)
and (6) (and specified in the plan under section 25(1)(d)), and

(b) must involve—

(i) the carer to whom the plan relates,

(ii) 25the adult needing care, if the carer asks the authority to do so,
and

(iii) any other person whom the carer asks the authority to involve.

(4) Where a local authority is satisfied that circumstances have changed in a way
that affects a care and support plan or a support plan, the authority must—

(a) 30to the extent it thinks appropriate, carry out a needs or carer’s
assessment, carry out a financial assessment and make a determination
under section 13(1), and

(b) revise the care and support plan or support plan accordingly.

(5) Where, in a case within subsection (4), the local authority is proposing to
35change how it meets the needs in question, it must, in performing the duty
under subsection (2)(b)(i) or (3)(b)(i), take all reasonable steps to reach
agreement with the adult concerned about how it should meet those needs.

28 Independent personal budget

(1) An independent personal budget is a statement which specifies what the cost
40would be to the local authority concerned (see section 24(3)) of meeting the
adult’s eligible needs for care and support.

(2) Where the amount referred to in subsection (1) includes daily living costs, the
independent personal budget for the adult must specify—

(a) the amount attributable to those daily living costs, and

(b) 45the balance of the amount referred to in subsection (1).

(3) An adult’s needs are “eligible needs” if, at the time they were met—

(a) they met the eligibility criteria,

(b) they were not being met by a carer, and

(c) the adult was ordinarily resident or present in the area of the local
authority.

(4) 5A local authority must—

(a) keep under review generally independent personal budgets that it has
prepared, and

(b) on a reasonable request by or on behalf of the adult to whom an
independent personal budget relates, review the independent personal
10budget.

(5) A local authority may revise an independent personal budget; and in deciding
whether or how to do so, it must, in so far as it is feasible to do so, involve—

(a) the adult to whom the independent personal budget relates,

(b) any carer that the adult has, and

(c) 15any other person whom the adult asks the authority to involve or,
where the adult lacks capacity to ask the authority to do that, any
person who appears to the authority to be interested in the adult’s
welfare.

(6) Where a local authority is satisfied that the circumstances of the adult to whom
20an independent personal budget applies have changed in a way that affects the
independent personal budget, the authority must—

(a) to the extent it thinks appropriate, carry out a needs assessment and
make a determination under section 13(1), and

(b) revise the independent personal budget accordingly.

(7) 25Where, in a case within subsection (6), an adult refuses a needs assessment and
the local authority thinks that the adult’s refusal is unreasonable, it need no
longer keep an up-to-date care account in the adult’s case.

(8) Having reviewed an independent personal budget, a local authority must—

(a) if it revises the independent personal budget, notify the adult to whom
30the independent personal budget relates of the revisions and provide
an explanation of the effect of each revision, or

(b) if it does not revise the independent personal budget, notify the adult
accordingly.

29 Care account

(1) 35Where an adult has needs for care and support which meet the eligibility
criteria, the local authority in whose area the adult is ordinarily resident or, if
the adult is of no settled residence, in whose area the adult is present—

(a) must keep an up-to-date record of the adult’s accrued costs (a “care
account”), and

(b) 40once those costs exceed the cap on care costs, must inform the adult.

(2) Where a local authority which has been keeping a care account is no longer
required to do so, it must nonetheless retain the account that it has kept so far
until—

(a) the end of the period of 99 years beginning with the day on which it last
45updated the account, or

(b) where the adult dies, the local authority becomes aware of the death.

(3) A care account must specify such amount as is attributable to the adult’s daily
living costs.

(4) A local authority which is keeping a care account must, at such times as
regulations may specify, provide the adult concerned with a statement
5which—

(a) sets out the adult’s accrued costs, and

(b) includes such other matters as regulations may specify.

(5) Regulations may specify circumstances in which the duty under subsection (4)
does not apply.

30 10Cases where adult expresses preference for particular accommodation

(1) Regulations may provide that where—

(a) a local authority is going to meet needs under sections 18 to 20 by
providing or arranging for the provision of accommodation of a
specified type,

(b) 15the adult for whom the accommodation is going to be provided
expresses a preference for particular accommodation of that type, and

(c) specified conditions are met,

the local authority must provide or arrange for the provision of the preferred
accommodation.

(2) 20The regulations may provide for the adult or a person of a specified description
to pay for some or all of the additional cost in specified cases or circumstances.

(3) “Additional cost” means the cost of providing or arranging for the provision of
the preferred accommodation less that part of the amount specified in the
personal budget for the purposes of section 26(1)(a) that relates to the provision
25of accommodation of that type.

Direct payments

31 Adults with capacity to request direct payments

(1) This section applies where—

(a) a personal budget for an adult specifies an amount which the local
30authority must pay towards the cost of meeting the needs to which the
personal budget relates, and

(b) the adult requests the local authority to meet some or all of those needs
by making payments to the adult or a person nominated by the adult.

(2) If conditions 1 to 4 are met, the local authority must, subject to regulations
35under section 33, make the payments to which the request relates to the adult
or nominated person.

(3) A payment under this section is referred to in this Part as a “direct payment”.

(4) Condition 1 is that—

(a) the adult has capacity to make the request, and

(b) 40where there is a nominated person, that person agrees to receive the
payments.

(5) Condition 2 is that—

(a) the local authority is not prohibited by regulations under section 33
from meeting the adult’s needs by making direct payments to the adult
or nominated person, and

(b) if regulations under that section give the local authority discretion to
5decide not to meet the adult’s needs by making direct payments to the
adult or nominated person, it does not exercise that discretion.

(6) Condition 3 is that the local authority is satisfied that the adult or nominated
person is capable of managing direct payments—

(a) by himself or herself, or

(b) 10with whatever help the authority thinks the adult or nominated person
will be able to access.

(7) Condition 4 is that the local authority is satisfied that making direct payments
to the adult or nominated person is an appropriate way to meet the needs in
question.

32 15Adults without capacity to request direct payments

(1) This section applies where—

(a) a personal budget for an adult specifies an amount which the local
authority must pay towards the cost of meeting the needs to which the
personal budget relates, and

(b) 20the adult lacks capacity to request the local authority to meet any of
those needs by making payments to the adult, but

(c) an authorised person requests the local authority to meet some or all of
those needs by making payments to the authorised person.

(2) If conditions 1 to 5 are met, the local authority must, subject to regulations
25under section 33, make the payments to which the request relates to the
authorised person.

(3) A payment under this section is referred to in this Part as a “direct payment”.

(4) A person is authorised for the purposes of this section if—

(a) the person is authorised under the Mental Capacity Act 2005 to make
30decisions about the adult’s needs for care and support,

(b) where the person is not authorised as mentioned in paragraph (a), a
person who is so authorised agrees with the local authority that the
person is a suitable person to whom to make direct payments, or

(c) where the person is not authorised as mentioned in paragraph (a) and
35there is no person who is so authorised, the local authority considers
that the person is a suitable person to whom to make direct payments.

(5) Condition 1 is that, where the authorised person is not authorised as
mentioned in subsection (4)(a) but there is at least one person who is so
authorised, a person who is so authorised supports the authorised person’s
40request.

(6) Condition 2 is that—

(a) the local authority is not prohibited by regulations under section 33
from meeting the adult’s needs by making direct payments to the
authorised person, and

(b) if regulations under that section give the local authority discretion to
decide not to meet the adult’s needs by making direct payments to the
authorised person, it does not exercise that discretion.

(7) Condition 3 is that the local authority is satisfied that the authorised person
5will act in the adult’s best interests in arranging for the provision of the care
and support for which the direct payments under this section would be used.

(8) Condition 4 is that the local authority is satisfied that the authorised person is
capable of managing direct payments—

(a) by himself or herself, or

(b) 10with whatever help the authority thinks the authorised person will be
able to access.

(9) Condition 5 is that the local authority is satisfied that making direct payments
to the authorised person is an appropriate way to meet the needs in question.

33 Direct payments: further provision

(1) 15Regulations must make further provision about direct payments.

(2) The regulations may, in particular, specify—

(a) cases or circumstances in which a local authority must not, or cases or
circumstances in which it has the discretion to decide not to, meet needs
by making direct payments;

(b) 20conditions which a local authority may or must attach to the making of
direct payments;

(c) matters to which a local authority may or must have regard when
making a decision of a specified type in relation to direct payments;

(d) steps which a local authority may or must take before, or after, making
25a decision of a specified type in relation to direct payments;

(e) cases or circumstances in which an adult who no longer lacks capacity
to request the making of direct payments must or may nonetheless be
regarded for the purposes of this Part or the regulations as lacking
capacity to do so;

(f) 30cases or circumstances in which a local authority making direct
payments must review the making of those payments.

(3) A direct payment is made on condition that it be used only to pay for
arrangements under which the needs specified under section 25(2)(a) in the
care and support plan or (as the case may be) the support plan are met.

(4) 35In a case where one or more of conditions 1 to 4 in section 31 is no longer met
or one or more of conditions 1 to 5 in section 32 is no longer met, the local
authority must terminate the making of direct payments.

(5) In a case where a condition specified under subsection (2)(b) or the condition
mentioned in subsection (3) is breached, the local authority—

(a) 40may terminate the making of direct payments, and

(b) may require repayment of the whole or part of a direct payment (with
section 67 accordingly applying to sums which the local authority
requires to be repaid).

Deferred payment agreements, etc.

34 Deferred payment agreements and loans

(1) Regulations may, in such cases or circumstances and subject to such conditions
as may be specified, require or permit a local authority to enter into a deferred
5payment agreement with an adult.

(2) A “deferred payment agreement” is an agreement under which a local
authority agrees not to require until the specified time either or both of the
following—

(a) the payment of the specified part of the amounts due from an adult to
10the authority under such provision of this Part or of regulations under
this Part as is specified in regulations;

(b) the repayment of the specified part of a loan made under the agreement
by the authority to an adult for the purpose of assisting the adult to
obtain the provision of care and support for the adult.

(3) 15The care and support mentioned in subsection (2)(b) includes care and support
the provision of which—

(a) the authority does not consider to be necessary to meet the adult’s
needs;

(b) is in addition to care and support which is being provided, arranged
20for, or paid for (in whole or in part) by the authority.

(4) Regulations under subsection (1) may, in particular, prohibit a local authority
from entering into, or permit it to refuse to enter into, a deferred payment
agreement unless it obtains adequate security for the payment of the adult’s
deferred amount.

(5) 25Regulations may specify what constitutes adequate security for the purposes
of subsection (4); they may, for example, specify—

(a) an obligation on the adult to give the authority a charge over the adult’s
legal or beneficial interest in the property which the adult occupies as
his or her only or main residence (or in a property which the adult used
30to occupy as such) to secure payment of the adult’s deferred amount;

(b) a guarantee from another person to pay the adult’s deferred amount.

(6) A reference in this section or section 35 to an adult’s deferred amount, in
relation to a deferred payment agreement, is a reference to the amount of
which the local authority agrees not to require payment or repayment until the
35specified time.

(7) “Specified”, in relation to a time or a part of an amount, means specified in or
determined in accordance with regulations; and the specified part of an
amount may be 100%.

(8) This section applies in relation to an agreement under which a local authority
40agrees to make a loan to an adult for the purpose of assisting the adult to obtain
the provision of care and support for the adult as it applies in relation to a
deferred payment agreement; and for that purpose—

(a) the reference in subsection (3) to subsection (2)(b) is to be read as a
reference to this subsection; and

(b) 45the references in subsections (4) and (5) to payment of the adult’s
deferred amount are to be read as references to repayment of the loan.

35 Deferred payment agreements and loans: further provision

(1) Regulations may require or permit a local authority to charge—

(a) interest on an adult’s deferred amount;

(b) such amount relating to the authority’s administrative costs as is
5specified in or determined in accordance with the regulations;

(c) interest on an amount charged under paragraph (b).

(2) The regulations may specify costs which are, or which are not, to be regarded
as administrative costs for the purposes of subsection (1)(b).

(3) The regulations may—

(a) 10require or permit adequate security to be obtained for the payment of
any interest or other amount referred to in subsection (1);

(b) require or permit any such interest or other amount to be treated in the
same way as the adult’s deferred amount;

(c) specify what constitutes adequate security for the purposes of
15paragraph (a).

(4) The authority may not charge interest under regulations made under
subsection (1) or under a deferred payment agreement at a rate that exceeds the
rate specified in or determined in accordance with the regulations; the
regulations may, for example, provide for a rate to be determined by reference
20to a specified interest rate or other specified criterion.

(5) The regulations must enable the adult to terminate a deferred payment
agreement by—

(a) giving the authority notice, and

(b) paying the authority the full amount for which the adult is liable with
25respect to the adult’s deferred amount and any interest or other amount
charged under regulations made under subsection (1) or under the
agreement.

(6) The regulations may make other provision about the duration of a deferred
payment agreement and for its termination by either party.

(7) 30The regulations may make provision as to the rights and obligations of the
authority and the adult where the adult disposes of any legal or beneficial
interest in a property to which a deferred payment agreement relates and
acquires a legal or beneficial interest in another property (whether or not it is
in the area of that authority); they may, for example, make provision—

(a) 35for the authority not to require payment of the amounts referred to in
subsection (5)(b) until the time specified in or determined in accordance
with the regulations;

(b) for the adult to give the authority a charge over the adult’s legal or
beneficial interest in the other property.

(8) 40The regulations may—

(a) require or permit terms or conditions of a specified description, or in a
specified form, to be included in a deferred payment agreement;

(b) permit such other terms or conditions as the authority considers
appropriate to be included in such an agreement;

(c) 45require statements or other information relating to specified matters, or
in a specified form, to be included in such an agreement.