The National Health Service (Direct Payments) Regulations 2013

Repayment of direct payments

15.—(1) A health body may require that part or all of a direct payment must be repaid to the health body, if satisfied that it is appropriate to require repayment having regard in particular to whether—

(a) the care plan has changed substantially;

(b) the patient’s circumstances have changed substantially;

(c) a substantial proportion of the direct payments received by a patient, representative or nominee have not been used to secure services specified in the care plan and have accumulated;

(d) the direct payments have been used otherwise than for a service specified in the care plan;

(e) theft, fraud or another offence may have occurred in connection with the direct payments; or

(f) the patient has died.

(2) Where a health body decides under paragraph (1) that a sum must be repaid, the health body must give reasonable notice in writing to the patient and any representative or nominee, stating—

(a) the reasons for the decision;

(b) the amount to be repaid;

(c) the time within which the sum must be repaid; and

(d) the person who must repay.

(3) In the case of a patient who has died, the notice mentioned in paragraph (2) must be given to the personal representatives of the patient.

(4) On receipt of a notice under paragraph (2), a patient, personal representative, representative or nominee may require a health body to re-consider the decision, and may provide evidence or relevant information for the health body to consider as part of that deliberation.

(5) A health body must inform the patient and any personal representative, representative or nominee in writing of the decision on a re-consideration, stating the reasons for the decision, the amount to be repaid, if any, the time within which any sum must be repaid and the person who must repay, if any.

(6) A health body may not be required to undertake more than one re-consideration following a decision under paragraph (1).

(7) A health body may waive any requirement pursuant to a decision under paragraph (1) or (4) for part or all of a direct payment to be repaid.