By Janice Jefferies, Legal Executive, Wrigleys Solicitors
When someone is catastrophically injured, an agency care package is usually put in place quickly, out of necessity, in the weeks after discharge.
Over time, though, a familiar frustration often sets in – rotating staff and limited continuity mean the client and their family struggle to build trusting relationships with carers.
Often, by that point, the client has identified the carers they want. Sometimes it is an agency worker they have bonded with, or someone the family already knows.
The question that follows is ‘how do we employ them directly and safely, when the client themselves lacks the capacity to do so?’
An Independent User Trust (IUT) is one answer to that question.
What an IUT actually does
An IUT is a unique trust structure born out of the Health and Social Care Act 2008. An IUT provides a means by which third parties can act as the employer of a person’s chosen carers when the person cannot fulfil that role themselves.
Professional or lay trustees take on the legal responsibilities of an employer, while day-to-day care delivery, recruitment support and clinical oversight can remain with a case manager, who typically operates under a service level agreement with the trust.
Families get continuity of care from people the client already knows and trusts.
The cost is often comparable or less than agency fees because the same funds are simply redirected through a different employment structure. And crucially, someone with proper legal and financial oversight is holding the employer’s responsibilities, reducing stress on the family.
Janice Jefferies
That last point matters more than it might first appear.
Employing a carer directly, even one carer, entails PAYE, pensions auto-enrolment, employers’ liability insurance, disciplinary and grievance processes, as well as TUPE considerations if staff transfer from an agency.
Families dealing with the aftermath of a life-changing injury are rarely able to take on these responsibilities personally, nor should they need to.
Working in a client’s best interests
A case study can help illustrate the effectiveness of the IUT approach.
John had sustained traumatic brain and spinal injuries at work and now requires 24-hour care and supervision.
His deputy had been managing an agency care package, but frequent carer changes were making it difficult for John and his wife to build stable relationships with the people supporting him daily.
Two particular carers stood out as ones he wanted to keep.
After a best-interests decision involving the deputy, the family, and the case manager, an IUT was established, with professional trustees acting as the employer.
The case manager took on recruitment, rota management, and clinical oversight under a service level agreement, while the trustees retained final authority over employment decisions, including a disciplinary matter and, later, a pay review to keep the package competitive and retain staff.
None of this happens by accident.
It requires close coordination among the trustees, the deputy, the case manager, and, at times, an independent financial advisor to ensure the arrangement remains affordable and firmly in the client’s best interests throughout.
What makes it work is not any single decision but the ongoing discipline of checking, at each stage, whether the structure still serves the client rather than simply persisting with it because of convenience.
Is an IUT the right solution?
IUTs are not a universal solution.
However, they can suit situations where a client has clearly identified carers they wish to retain, where the numbers stack up, and where there is a trustee body willing to take on the ongoing oversight role properly, not just at the point of set-up.
Ongoing management is essential to ensure the trust operates successfully.
Getting the legal set up right at the outset, the IUT deed, the service level agreement, and the employment documentation matter enormously, as does having someone available to advise as circumstances change.
If you are working with a client where this kind of arrangement might be worth exploring, Wrigleys are more than happy to help.
Health and social care professionals work within a complex and tightly regulated legal framework, where the right course of action is not always clear.
The Wrigleys Health and Care team brings deep legal expertise and practical experience to help individuals and organisations understand their rights, responsibilities, and options.
We work closely with our clients, taking the time to understand what matters to them and providing clear, pragmatic advice focused on achieving fair and workable outcomes.
Learn more at wrigleys.co.uk
