Assessment, Care & Support Planning and Review Policymoderngov.staffordshire.gov.uk/documents/s77976/Enc... · Personal Budgets 15 Care & support planning 17 ... ensuring at all times

Gateway Number:

Version:

Status: Final

Document Summary:

This document outlines the approach taken by Staffordshire County Council to meeting its obligations in regard to assessment, care and support planning and review arrangements for adults with the appearance of need for care and support and carers with the appearance of need for support.

Policy Authors:

Kevin Thompson / Andrew Errington

Policy Lead/Sponsor:

Nichola Glover-Edge

Source of Approval:

N/A

Date of Approval:

N/A

Document Date:

January 2015

Review Date:

January 2017

Equality Impact Assessment

Governance Checklist

POLICY AWARENESS

People who need to know this policy in detail

Staffordshire Contact Centre staff Commissioned Provider Organisations providing assessment, support planning and review functions as required by SCC. All front line staff involved in the undertaking of Care Act assessments of need, care and support planning and reviews.

People who need to have a broad understanding of this policy

Staffordshire County Council Lead Commissioners Clinical Commissioning Groups Staffordshire Healthwatch

People who need to know that this policy exists

Staffordshire County Council Members The general public.

CHANGE CONTROL DETAILS Date Version Description Reason for changes

Assessment, Care & Support Planning and Review Policy

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www.staffordshire.gov.uk

Contents

Introduction 3

Purpose 3 Explanation of Terms 4 Duties and Responsibilities 5 The Well-being principle 5

Personalisation 6

Assessment 8

Eligibility 15

Personal Budgets 15 Care & support planning 17

Reviews 22

Self-funders 26 Consultation, Approval and Ratification Process 27 Dissemination and Implementation 27 Monitoring Compliance 28 References and Supporting Documents 28 Policy Review 28 Appendices 29

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Introduction Under the Care Act 2014 the council has a statutory duty to assess an adult’s need for care & support, and a carer’s need for support. In addition the Act sets out Staffordshire County Council’s (SCC) duty to meet needs for care and support, and for the review of such needs.

Staffordshire County Council operates a series of integrated commissioning arrangements that bring together not only health and social care, but also establish clear connections with wider partners in housing, criminal justice, education and public health in order to facilitate coherent and connected actions to address the challenges facing Staffordshire people.

The SCC has commissioned a range of operational partners to deliver the aspirations and statutory requirements of the Care Act in line with its powers to delegate functions covered by this policy. Operational partners will support adults with social care needs and carers with needs for support to be:

As independent as possible.

Have the knowledge and support to make informed decisions;

Have choice and be in control of decisions about their care;

Be part of a community;

Receive support at the right time. Operational partners for services covered by this policy are as follows:

Staffordshire County Safeguarding Teams

Staffordshire County Council Contact Services

Staffordshire County Council Independent Futures

Staffordshire County Council Families First

Staffordshire County Council Emergency Duty Teams

Staffordshire & Stoke on Trent Partnership NHS Trust

South Staffordshire and Shropshire NHS Foundation Trust

North Staffordshire Combined Healthcare NHS Trust Purpose This policy sets out the framework for assessment, support planning and review in Staffordshire. Operational partners will provide an access pathway to assessment and support planning that provides a single journey through to service provision and review, ensuring at all times that assessment and support planning processes are personalised and put the person at the centre of the process. Operational partners will ensure that Statutory Guidance is reflected and implemented throughout the pathways that they put in place to implement the Councils priorities. In addition, operational partners will provide staff with standardised operating procedures and guidance to ensure that national guidance is reflected in operational practice. This policy should be read in conjunction with those policies providing more detail on elements of care and support. These include:

Direct payments

Transition to Adult Care and Support

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Prisons, approved premises and bail accommodation

Moving between areas (ordinary residence, continuity of care and cross border placements)

Explanation of Terms Care and Support

Care and support is the term used to describe the help some adults need to live as well as possible with any illness or disability they may have.

Assessment

A needs assessment is a discussion between the person (or the person they look after) and a trained person either from the council or another organisation that the council works with, where the person can talk about the care and support needs they have and the goals they want to achieve. It could be done face to face, over the telephone or online. The council uses the assessment to identify the care and support needs, and to discuss how these could be met.

Carer Somebody who provides support or who looks after a family member, partner or friend who needs help because of their age, physical or mental illness or disability. This would not usually include someone paid or employed to carry out that role, or someone who is a volunteer.

Carers Assessment

A carer’s assessment is for someone who gives care and support to an adult family member or friend. A carer’s assessment will look at the different ways that caring affects a person’s life and work out how people can carry on doing the things that are important to them and their family. Their physical, mental and emotional wellbeing will be at the heart of this assessment. A carer can have a carer’s assessment even if the person they care for does not get any help from the council, and they will not need to be assessed.

Personal budget This is a statement that sets out the cost to the Local Authority of meeting an adult’s care needs. It includes the amount that the adult must pay towards that cost themselves (on the basis of their financial assessment), as well as any amount that the Local Authority must pay. Direct payment Payments made directly to someone in need of care and support by their Local Authority to allow the person greater choice and flexibility about how their care is delivered.

Care and Support Plan

A care and support plan is the document that is agreed between the Local Authority and the person which sets out assessed needs for care & support, both eligible and non-eligible, and how these needs will be met and paid for.

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Duties and Responsibilities The duties including levels of responsibility are outlines as follows:

Managers Managers of all Social Care and Health services have responsibilities to ensure that all staff are made aware of the requirements regarding assessment, care and support planning and review. Staff All Social Care and Health staff have responsibilities to familiarise themselves with and act in accordance with the policy. The Well-Being Principle Overview The Care Act requires that SCC promotes the well-being of the individual throughout all of its activities and procedural frameworks. For the purpose of this policy the Council requires its operational partners to promote the well-being of adults with needs for care & support, and carers with need for support. The promotion of wellbeing is at the heart of the Care Act vision of care & support. Its purpose is to promote wellbeing by helping people to achieve the outcomes that matter to them in their lives. The Act signifies a shift away from past legal requirements on Local Authorities to provide particular services. Local Authorities must now meet the needs that impact on the wellbeing of adults who need care & support and their carer’s. Definition of wellbeing under the Care Act The Care Act regards the aspects or principles of wellbeing as those which are most relevant to people with care and support needs and their carer’s. Under the Act there is no hierarchy, and all aspects should be considered of equal importance when considering the requirement to promote wellbeing.

Personal dignity (including treating people with respect).

Physical, mental health and emotional wellbeing

Protection from abuse and neglect

Control by the individual over day-to-day life, including over care and support

provided and the way it is provided.

Participation in work, education, training or recreation.

Social and economic wellbeing

Domestic, family and personal circumstances

Suitability of living accommodation

The individual’s contribution to society.

Where the county council is required to meet need under section 117 of the Mental Health Act 1983 the guidance on support planning should be read in conjunction with chapter 34 of the Mental Health Act 1983 Code of Practice.

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Promoting wellbeing

The duty to promote wellbeing involves actively seeking improvements in these aspects of wellbeing when carrying out a care & support function. The duty applies at any stage from the provision of information and advice to an individual, to assessment, care & support planning or support planning for carers and review. The concept of promoting wellbeing includes the importance of preventing or delaying the development of needs for care & support, or support for carers, and the importance of reducing needs that already exist. Each person’s situation should be considered on its own merits and in the light of what the individual wants to achieve. The concept of meeting needs under the Act recognises that care & support, or support for carer’s, can be provided in any number of ways. Local Authorities must look at how to meet each person’s specific needs rather than simply considering which service they might fit into. Some aspects of wellbeing will be more relevant than others in specific cases. A flexible approach should be taken which allows a focus on the aspects of wellbeing that matter most to the individual concerned. The wellbeing principles apply equally to those who do not have eligible needs but who come into contact with the system, as to those who do have eligible needs. They should inform the delivery of universal services and the provision of information, advice and support. Impact of wellbeing principles on practice

Local Authorities must avoid restricting support options to traditional menus of directly provided or Local Authority commissioned services. A core requirement of the Act is an assessment and planning process that is a genuine conversation about people’s needs for care and support rather than matching the individual’s needs to existing services. Systems must be in place that give people the information they need to take control of their support and to choose from a range of options that are right for them. Partner organisations delivering care and support cannot work in isolation from each other. The person must be the starting point for planning rather than which services are provided by which agency. People should remain in control of their own care & support regardless of changing circumstances. The wellbeing principle of control means that under the Act people will be able to move from one area to another or from children’s services to the adult system, seamlessly and without losing their care and support. Personalisation The Council is committed to the principle of personalisation and person centred support. The placing of the person at the centre of the assessment & support planning process is central to the Care Act. Operational partners will support the Council by ensuring their operational procedures enable people with a need for support to be able to say: Information and advice “I have the information and support I need in order to remain as independent as possible”.

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“I have access to easy to understand information about care and support which is consistent, accurate, accessible and up to date”. “I can speak to people who know something about care and support and can make things happen”. “I have help to make informed choices if I need and want it”. “I know where to get information about what is going on in my community”. Active and Supportive Communities “I have access to a range of support that helps me live the life I want and remain a contributing member of my community”. “I have a network people who support me – carers, family, friends, community and if needed, paid support staff”. “I have opportunities to train, study, work or engage in activities that match my interests, skills and abilities”. “I feel welcomed and included in my community”. “I feel valued for the contribution I can make to my community”. Flexible integrated care and support “I am in control of planning my care and support”. “I have care and support that is directed by me and responsive to my needs”. “My support is coordinated, co-operative and works well together and I know who to contact to get things changed”. “I have a clear line of communication, action and follow up”. Workforce “I have good information and advice on a range of options for choosing my support staff”. “I have considerate support delivered by competent people”. “I have access to a pool of people, advice on how to employ them and the opportunity to get the advice from my peers”. “I am supported by people who help me make links with my local community”. Risk enablement “I can plan ahead and keep control in a crisis”. I feel safe, I can live the life I want and I am supported to manage any risks”. I feel that my community is a safe place to live and local people look out for me and each other”. Personal Budgets and self-funding “I can decide the kind of support I need and when, where and how to receive it”. “I know the amount of money available to me for care and support needs, and I can determine how this is used (whether it’s my own money, direct payment or council managed personal budget)”. “I can get access to the money quickly without having to go through over complicated procedures”. “I am able to get skilled advice to plan my care and support, and also be given help to understand costs and make the best use of the money involved where I want and need this”.

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Assessments Overview The assessment and eligibility process is one of the most important elements of the care and support system. The assessment is one of the key interactions between a Local Authority and an individual, whether an adult needing care or a carer. The process must be person centred throughout. Eligibility determinations must be made on the basis of an assessment, and cannot be made without first having carried out an assessment. Adults The Local Authority must undertake an assessment for any adult with the appearance of need for care& support, regardless of whether or not the Local Authority thinks the individual has eligible needs or of their financial situation. The needs assessment must include an assessment of the impact of the adult’s needs for care and support on the following:

personal dignity (including treatment of the individual with respect);

physical and mental health and emotional well-being;

protection from abuse and neglect;

control by the individual over day to day life (including over care and support, or support, provided to the individual and the way in which it is provided);

participation in work, education, training or recreation;

social and economic well-being;

domestic, family and personal relationships;

suitability of living accommodation;

the individual’s contribution to society. The needs assessment must also include an assessment of the outcomes the individual wishes to achieve in day-to-day life and whether, and if so to what extent, the provision of care and support could contribute to the achievement of those outcomes. Prevention, reduction and delaying of need is a key component of the Act and it should be noted that the assessment process can be ‘paused’ at any time to allow for preventative interventions to take place and for their impact to be evaluated. The assessor must always consider whether, and to what extent, the provision of things other than care and support might contribute to the adult achieving their outcomes, for example information and advice or preventative services. The assessor must include the adult, any person whom the adult asks to be involved, or, where the adult lacks capacity, any person who appears to be interested in the adult’s welfare. Carer’s assessments of needs for support The council will, through its commissioned providers, ensure that where it appears that a carer may have needs for support (whether now or in the future) the provider will be expected to assess whether the carer does have needs for support (or is likely to do so in the future) and if so what those needs are or are likely to be.

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Carer means an adult who provides or intends to provide care for another adult (an adult needing care). An adult providing care under contract or in a voluntary capacity is not to be regarded as a carer unless the assessor deems this to be appropriate. The duty to assess applies regardless of the provider’s view of the care’s level of need for support or the level of the carer’s finances, or the finances of the person being cared for. A carer’s assessment must include an assessment of:

Whether the carer is able, or is likely to continue to be able, to provide care for the adult needing care;

Whether the care is willing, and is likely to continue to be willing, to do so;

The impact of the carer’s needs for support on the following: - Personal dignity (including treatment of the individual with respect;

- Physical and mental health and emotional well-being; - Protection from abuse and neglect; - Control by the individual over day to day life (including over care and support,

or support, provided to the individual and the way in which it is provided); - Participation in work, education, training or recreation; - Social and economic well-being; - Domestic, family and personal relationships; - Suitability of living accommodation; - The individual’s contribution to society.

The carer’s assessment must also include an assessment of the outcomes the carer wishes to achieve in day-to-day life and whether, and if so to what extent, the provision of support could contribute to the achievement of those outcomes. The assessment should consider whether a carer wishes to work and whether the carer wishes to participate in education, training or recreation. The assessor must include the carer and any person the carer asks to be involved. The assessor must also consider whether, and to what extent, the provision of things other than support might contribute to the carer achieving their outcomes, for example information and advice or preventative services. Refusal of assessment Where an adult refuses a needs assessment the provider is not required to carry out a needs assessment unless:

The adult lacks capacity to refuse the assessment and the provider is satisfied that carrying out the assessment would be in the adult’s best interests; or, the adult is experiencing, or is at risk of, abuse and neglect.

Where a carer refuses a carer’s assessment, the provider is not required to carry one out unless:

Having previously refused an assessment the carer subsequently requests one or the provider thinks that the needs or circumstances of the carer or the adult

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needing care have changed in which case the provider must assess unless it is again refused by the carer.

First Contact The provision of information, advice and guidance (IAG) will be made as early as possible about the assessment process, and will include the format and timescale of the assessment, complaints processes and, in appropriate circumstances, access to independent advocacy if the adult has substantial difficulty in being involved in the assessment process. Information should be in an accessible format, for example, braille. Providers of assessment services will not remove people too early from the process. Early or targeted interventions such as universal services, reablement, provision of equipment or minor household adaptations can delay an adult’s needs from progressing. Assessments can be paused to allow preventative interventions to take place and for their impact on the person to be evaluated. Timescales for assessments will be appropriate and reasonable and the person will be kept informed of indicative timescales throughout the process. Staff involved in first contact will be appropriately trained including being able to identify a person who may lack mental capacity and be able to act accordingly. They will have access to professional support from social workers, occupational therapists and other relevant experts as appropriate. First contact services will be able to respond to urgent needs in instances where assessments have not been completed. Where an individual with urgent needs becomes known to the provider they will provide an immediate response in order to meet the individual’s care and support needs, regardless of their ordinary residence. Supporting the person’s involvement in the assessment Putting people at the heart of the assessment process is crucial to understanding the person needs, outcomes and wellbeing, and delivering better care and support. Where the provider identifies that an adult is unable to effectively engage in the assessment process independently, it will seek to involve somebody to help them articulate their preferred outcomes and needs as early as possible. This will include some people will mental impairments who never the less have capacity to engage. Appropriate support will be offered to enable the person to engage with an assessment tailored to their circumstances. Where appropriate, assessments of mental capacity will be carried out under the Mental Capacity Act (MCA) and where appropriate Independent Mental Capacity Advocates will be appointed to support the person. Social workers and other professionally qualified staff will advise and support staff carrying out assessments for a person who might lack capacity. Independent Advocates At the point of first contact the Local Authority or its providers will ascertain whether an individual is able to be involved in the assessment and whether they will have substantial difficulty doing so. They will need to consider whether the person understands the information provided; whether they can retain the information; whether they can use or

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weigh up the information and whether they can communicate their views, wishes or feelings. When a person has substantial difficulty in any of the four areas then they will be provided with assistance. If a person does have substantial difficulty the provider will find an appropriate and independent person to support and represent the person. Where there is a family member or friend who is willing and able to support the person’s involvement effectively, and where that person is acceptable to the person being assessed, and is judged appropriate by the assessor, then they can be asked to support the person. If no such person is available then the provider must appoint an independent advocate. Prevention It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it is vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible. In assessing whether an adult has any care and support needs or a carer has any needs for support, the Local Authority must consider whether the person concerned would benefit from the preventative services, facilities or resources provided by the Local Authority or which might otherwise be available in the community. This is regardless of whether, in fact, the adult or carer is assessed as having any care and support needs or support needs. This is to ensure that as part of the assessment process, the Local Authority considers the capacity of the person to manage their needs or achieve the outcomes which matter to them, and allows for access to preventative support before a decision is made on whether the person has eligible needs. Early or targeted interventions such as universal services, a period of re-ablement and providing equipment or minor household adaptions can delay an adult’s needs from progressing. The first contact with the authority, which triggers the requirement to assess, may lead to a pause in the assessment process to allow such interventions to take place and for any benefit to the adult to be determined. Local Authorities must ensure that their staff are sufficiently trained and equipped to make the appropriate judgements needed to steer individuals seeking support towards information and advice, preventative services or a more detailed care and support assessment, or all of these. Appropriate and proportionate assessments All assessments, whether for adults with an appearance of need for care and support, or for carers will be proportionate. Providers of assessment services will ensure that the level of assessment undertaken fulfils its duties regarding safeguarding, independent advocacy and assessing mental capacity. All assessors will have the skills, knowledge and competence to carry out the assessment in question. Some people being assessed may have severe communication needs such as people with multiple and profound learning disabilities, autistic spectrum disorder or those who are deaf blind. Such individuals may need the support of a specialist interpreter to help them engage with the assessment.

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When carrying out proportionate assessments providers must have regard to the persons preferences and desired outcomes; the severity and overall extent of the person’s needs – for example someone with more complex needs will require a more detailed assessment – and the potential fluctuation of the person’s needs. When carrying out a proportionate assessment the assessor will continue to look for needs which may be the result of an underlying condition and will refer the person to other agencies as required. Fluctuating Needs As the condition of the individual at the time of the assessment may not be entirely indicative of their needs more generally, Local Authorities must consider whether the individual’s current level of need is likely to fluctuate and what their ongoing needs for care and support are likely to be. The assessment should also include a consideration of the individual’s wider care and support needs. This may include types of carer and support the individual has received in the past and their general medical history, which may be indicative of their current care and support needs. Supported self-assessment A supported self-assessment is an assessment carried out jointly by the adult with care and support needs and the assessor. When a person is self-assessing it is still the responsibility of the Local Authority to ensure the assessment is accurate and complete. Self-assessment is a voluntary undertaking. The person should be asked to complete the same assessment questionnaire that the provider uses in its users or carers assessments and should ensure the person has capacity to assess and fully reflect their needs. Where appropriate the provider must consider the provision of an independent advocate or a specialist who has specific training and experience to assist the person to be involved. Those undertaking self-assessments must be supported by the provider giving the person any relevant information the provider has about the person, or in the case of a carers self-assessment, of the person being cared for. Consent for the sharing of such information should always be obtained and if the person lacks capacity to consent the provider must be satisfied that this is in the person’s best interests. In the case of young carers the provider must consider whether it is appropriate to share information about the person the young carer cares for. Providers must ensure self-assessments are complete and accurate and the assessment is not considered to be complete until this assurance is given. Once satisfied that the assessment is complete and accurate then it must make an eligibility decision. The final decision regarding eligibility rests with the Local Authority who must inform the person of its eligibility judgement. Where the provider deems needs to be ineligible it must provide the person with IAG on what community and universal services are available to support the person. Safeguarding Where, during an assessment it appears to the assessor that the person is experiencing, or is at risk of abuse or neglect they must ensure that a safeguarding referral is made to the Multi Agency Safeguarding Hub (MASH). The decision to make a referral does not depend

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on a person’s eligibility, but should be made where there is reasonable cause to think the person is experiencing, or is at risk of, abuse or neglect. The safeguarding team will carry out (or will ask others to carry out) whatever enquiries it thinks are necessary in order to decide if further action is necessary. Where the adult has care and support needs the provider must continue to carry out a needs assessment and determine if they have eligible needs, and if so how these needs will be met. The assessment for care & support should run parallel to the safeguarding enquiry and the enquiry should not disrupt the assessment process or the process of meeting eligible needs. Whole family approach SCC and its commissioned providers will need to ensure that assessors consider the impact of the person’s needs on family members or others involved with the person as appropriate. This will involve the assessor identifying anyone who may be part of the person’s wider network of care and support. Providers must have specific regard to the identification of any children who are involved in providing care. If it appears that a child is providing care then the assessor should ensure that the provisions of the Carers Policy are implemented. This includes a consideration of whether to refer the young Carer for an assessment under s63 of the Care Act or a needs assessment under the Children Act 1989. The assessor should have regard to the provisions of the Carers Policy including a consideration of whether any of the caring tasks the child is undertaking are inappropriate and are likely to have a negative impact on the child’s health, well-being or education. The assessor should take into account the child’s own views as appropriate. Considering the person’s strengths and capabilities At the same time as carrying out the assessment, the Local Authority must consider what else other than the provision of care and support might assist the person in meeting the outcomes they want to achieve. In considering what else might help, authorities should consider the person’s own strengths and capabilities, and what support might be available from their wider support network or within the community to help. Strengths-based approaches might include co-production of services with people who are receiving care and support to foster mutual support networks. Encouraging people to use their gifts and strengths in a community setting could involve developing residents’ groups and appropriate training to support people in developing their skills. Local Authorities might also consider the ways a person’s cultural and spiritual networks can support them in meeting needs and building strengths, and explore this with the person. Any suggestion that support could be available from family and friends should be considered in light of their appropriateness, willingness and ability to provide any additional support and the impact on them of doing so. It must also be based on the agreement of the adult or carer in question. Combining assessments and integrating assessments A holistic approach to assessment which aims to bring together all of the persons needs may need the input of different professionals. The assessment can be carried out jointly with another body carrying out any other assessment provided the person agrees. An integrated approach may involve working together with relevant professional on a single assessment. Where more than one agency is assessing a

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person, they should all work together closely to prevent that person having to undergo a number of assessments at different times.

People who do not have a single defined set of needs or clear diagnosis often have difficulty in accessing the right services at the right time. This can often lead to delay in assessment and service provision leading to dissatisfaction. The principle of person-centred care should guide staff and interventions should be based on needs, not on a diagnosis. The service user’s needs are paramount during any initial assessment and any transitional period from one service or team to another. Any team or service which first receives a referral should take all the details and co-ordinate the initial response and screening assessment. If it appears that they are not the most appropriate team/service to deal with the case, they should negotiate transfer but not leave the person unsupported. If there is any disagreement or difficulty in negotiating case management responsibility, it should be referred to service managers/team leaders for a peer discussion. NHS Continuing Healthcare Where it appears that a person may be eligible for NHS Continuing Healthcare (NHS CHC), Local Authorities must notify the relevant Clinical Commissioning Group (CCG). NHS CHC is a package of on-going care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Novembe2012) (Revised). Individuals may require care and support provided by their Local Authority and/or services arranged by CCGs. Local Authorities and CCGs therefore have a responsibility to ensure that the assessment of eligibility for care and support and CHC respectively take place in a timely and consistent manner. If, following an assessment for NHS CHC, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person’s health needs – either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both an LA and a CCG, this is known as a ‘joint package’ of care. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a Local Authority to meet. The joint package could also involve the CCG and the Local Authority both contributing to the cost of the care package, or the CCG commissioning part of the package. Training SCC and its commissioned providers will be required to ensure that assessors are appropriately trained and competent whenever they carry out an assessment. Assessors will be offered up-to-date training on a regular basis. The training must be appropriate to the assessment, both to the format of assessment and the conditions and circumstances of the person being assessed. They must also have the skills and knowledge to carry out an assessment of needs that relate to a specific condition or circumstances requiring expert insight, for example when assessing an individual who has autism, learning disabilities, mental health needs or dementia. When assessing particularly complex or multiple needs, an assessor may require the support of an expert to carry out the assessment.

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Where an assessor does not have the experience in a particular condition, they must consult someone with relevant experience. Assessment for people who are deafblind Providers must ensure that an expert is involved in the assessment of adults who are deafblind, including where a deafblind person is carrying out a supported self-assessment. People will be regarded as deafblind if their combined sight and hearing impairment causes difficulties with communication, access to information and mobility. This includes people with a progressive sight and hearing loss. If a person is considered deafblind this must trigger a specialist assessment by an assessor or team that has training of at least QC OCN level 3, or above where a person has complex needs. Eligibility

The national eligibility criteria set a minimum threshold for adult care and support needs and carer support needs which Local Authorities must meet. All Local Authorities must comply with this national threshold. Local Authorities can also decide to meet needs which are not deemed to be eligible if they chose to do so. Following the completion of the assessment, where the commissioned provider believes that an adult has a need for care and support, or a carer has a need for support the provider must determine whether any of the assessed needs are eligible needs as defined by the Eligibility Criteria. Following this determination, the adult or the carer will be provided with a written copy of the determination and the reasons for it. Personal Budgets Overview The personal budget is the mechanism that, in conjunction with the care and support plan, or support plan, enables the person and their advocate if they have one, to exercise greater choice and take control over how their care and support needs are met. It means:

knowing, before care and support planning begins, an estimate of how much money will be available to meet a person’s assessed needs and, with the final personal budget, having clear information about the total amount of the budget, including proportion the Local Authority will pay, and what amount (if any) the person will pay;

being able to choose from a range of options for how the money is managed, including direct payments, the Local Authority managing the budget and a provider or third party managing the budget on the individual’s behalf (an individual service fund), or a combination of these approaches;

having a choice over who is involved in developing the care and support plan for how the personal budget will be spent, including from family or friends;

having greater choice and control over the way the personal budget is used to purchase care and support, and from whom.

Everyone whose needs are met by the Local Authority, whether those needs are eligible, or if the authority has chosen to meet other needs, must receive a personal budget as part of the care and support plan, or support plan.

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The personal budget is an important tool that gives the person clear information regarding the money that has been allocated to meet the needs identified in the assessment and recorded in the plan. An indicative amount should be shared with the person, and anybody else involved, at the start of care and support planning, with the final amount of the personal budget confirmed through this process. The detail of how the personal budget will be used is set out in the care and support plan, or support plan. The personal budget must always be an amount sufficient to meet the person’s care and support needs, and must include the cost to the Local Authority of meeting the person’s needs which the Local Authority is under a duty to meet, or has exercised its power to do so. This overall cost must then be broken down into the amount the person must pay, following the financial assessment, and the remainder of the budget that the authority will pay. The Care and Support (Personal Budget Exclusion of Costs) Regulations 2014 set out that the provision of intermediate care and reablement services, for which the Local Authority cannot or chooses not to make a charge, must be excluded from the personal budget. Calculating the personal budget A number of systems can be used to arrive at personal budget amounts, ranging from complex algorithmic-based resource allocation systems (RAS), to more ‘ready reckoner’ approaches. Regardless of the process used, the most important principles in setting the personal budget are transparency, timeliness and sufficiency Use of the personal budget The person should have the maximum possible range of options for managing the personal budget, including how it is spent and how it is utilised. Directing spend is as important for those choosing the council-managed option or individual service fund as for direct payments There are three main ways in which a personal budget can be deployed:

As a managed account held by the Local Authority with support provided in line with the persons wishes;

As a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the persons wishes;

As a direct payment. In addition, a person may choose a ‘mixed package’ that includes elements of some or all three of the approaches above Care and Support Planning Overview Care and support should put people in control of their care. A vital part of this process for people with ongoing needs which the Local Authority is going to meet is the care and support plan.

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Following the needs and carer’s assessment and determination of eligibility a plan must be provided where the council is required to meet needs under section 18 or 20(1) of the Care Act, or decides to meet needs under section 19(1) or (2) and 20(6) of the Act. Meeting needs is an important concept under the Act and moves away from the previous terminology of ‘providing services’. This provides a greater variety of approach in how needs can be met, developed through care and support planning. The concept of meeting needs is intended to be broader than a duty to provide or arrange a particular service. Because a person’s needs are specific to them, there are many ways in which their needs can be met. The purpose of the care and support planning process is to agree how a person’s needs should be met, and therefore how the Local Authority will discharge its duty, or its power, to do so. Where a Local Authority is required to meet needs under section 117 of the Mental Health Act 1983 this chapter should be read in conjunction with chapter 34 of the Mental Health Act 1983 Code of Practice (on the Care Programme Approach) and Refocusing the Care Programme Approach. Where the Council is not required to meet needs, it nonetheless may use its power to meet any other needs. This may include, for example, meeting needs which are non-eligible. Where the Local Authority exercises such a power, the same duties would apply regarding the next steps, and therefore a plan must be provided. How to undertake care and support planning, and support planning The plan will detail the needs to be met and how the needs will be met, and will link back to the outcomes that the individual wishes to achieve in everyday life as identified in the assessment process and wellbeing principle. This should reflect the individual’s wishes, their needs and aspirations, and what is important to then, where this is reasonable. The guiding principle is that the person be actively involved in influencing the planning and content of the plan. Production of the plan The plan should be person centred. The planning choices offered should range from support to the person; to jointly plan with the councils representative and their family and / or friends, peers, or others, or on a 1:1 basis with the paid professional. If the person has substantial difficulty in being involved then appropriate action will be required to facilitate their involvement. The plan must contain certain elements as follows unless excluded by the Care and Support (Personal Budget Exclusion of costs) regulations 2014:

The needs identified by the assessment;

Whether, and to what extent, the needs meet the eligibility criteria;

The needs that the authority is going to meet and how it intends to do so;

For a person needing care, for which of the desired outcomes care and support could be relevant;

The personal budget ( see personal budget policy);

For a carer, the outcomes the carer wishes to achieve, and their wishes around providing care, work, education and recreation where support could be relevant;

The personal budget ( see personal budget policy);

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Information and advice on what could be done to reduce the needs in question, and to prevent delay or reduce development of needs In future;

Where needs are being met via a direct payment, the needs to be met by the direct payment and the amount and frequency of payments.

Support plans should consider the extent to which a person’s needs or circumstances mean they are at risk of neglect or abuse. Specific interventions to address a safeguarding issue may be included. The plan must consider any needs being met by a carer. Providing the care is willing and able to continue caring the council is not required to meet those needs. If the carer has eligible needs then support plans can be combined. The plan should consider how universal and community based / unpaid support could contribute to the plan, including support that builds social support and capital. Plans should be proportionate to the needs being met. Where a person has fluctuating needs then the plan needs to make provisions to accommodate this, rather than being decided at crisis point. There should be no restriction or limit on the type of information the plan contains as long as it is relevant to the outcomes: the person should be able to develop their plan in a format that makes sense to them rather than in a proscribed format. People should be offered information regarding which of their needs could be met by a direct payment. This information should be provided upfront to assist the person to decide whether they wish to request a direct payment to meet some or all of their needs and should also be available at various points in the process to ensure to the option is kept under consideration. Involving the person In addition to taking all reasonable steps to agree how needs are to be met, the Local Authority must also involve the person the plan is intended for, the carer (if there is one), any other person the adult requests to be involved. Where the person lacks capacity to ask the authority to do that, the Local Authority must involve any person who appears to the authority to be interested in the welfare of the person and should involve any person who would be able to contribute useful information. An independent advocate must be provided if required. The person, and their carers, will have the best understanding of how the needs identified fit into the person’s life as a whole and connect to their overall wellbeing. Where the person lacks capacity, the Local Authority should make a best interest’s decision about who else should be involved. The person should be supported to understand what is being discussed and what options are available for them. In all cases, people should be allowed to gain support from individuals who they choose to assist their involvement in the planning process. Genuine involvement will aid the development of the plan, increase the likelihood that the options selected will effectively support the adult in achieving the outcomes that matter to

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them, and may limit disputes as people involved will be fully aware and have agreed to decisions made. Authorising others (including the person) to prepare the plan jointly with the Local Authority Where a plan is being jointly prepared by the Local Authority and the person whose plan it is, or the Local Authority and a third party, the Local Authority should ensure that relevant information is shared securely, promptly and in accordance to the Data Protection Act to allow the plan to be prepared in a timely fashion. A partnership approach should be taken, where each partner knows their role and the parties supported to identify options and choose between them. The Local Authority should also consider cases or circumstances where it may not be appropriate to jointly prepare the plan. For example, a person may not wish their family to be involved, or the authority may be aware that family members may have conflicting interests, or the person may have asked the Local Authority to prepare the plan with someone who lives far away from the person and even with the assistance of email, phone and other methods of communication is unable to prepare the plan in a timely fashion. The test for allowing the person and others to prepare the plan jointly with the Local Authority should start with the presumption that the person at the heart of the care plan should give consent for others to do so; and should also have safeguarding principles embedded to ensure that there is no conflict of interest between the person and the third party they wish to involve to prepare the plan jointly with. Where a person lacks capacity and cannot consent to third parties jointly preparing the plan, the Local Authority must always act in the best interests of the person requiring care and support. Planning for people who lack capacity Good, person-centred care planning is particularly important for people with the most complex needs. Many people receiving care and support have mental impairments, such as dementia or learning disabilities, mental health needs or brain injuries. The principles of the Care Act apply equally to them, in addition to the principles and requirements of the Mental Capacity Act 2005 (MCA) if the person lacks capacity. The MCA requires that all providers assume that people have capacity and can make decisions for themselves, unless otherwise established. Every adult has the right to make his or her own decisions in respect of his or her care plan, and must be assumed to have capacity to do so unless it is proved otherwise. This means that Local Authorities cannot assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability. Local Authorities must understand that people have the right to make what others might regard as an unwise or unusual decision. Everyone has their own values, beliefs and preferences which may not be the same as those of other people. People cannot be treated as lacking capacity for that reason. If a Local Authority thinks a person may lack capacity to make a decision or a plan, even after they have offered them all practicable support, a social worker or other suitably qualified professional should carry out a capacity assessment in relation to the specific decision to be made.

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Where an individual has been assessed as lacking capacity to make a particular decision, then the Local Authority must commence care planning in the person’s best interests under the meaning of the MCA The duty to involve the person remains throughout the process. If lack of capacity is established, it is still important that the person is involved as far as possible in making decisions. Planning should always be done with the person and not for them and should always consider their wellbeing in the wider context of their rights to security, to liberty, and to family life. Minimising and authorising deprivation of liberty (DOL) for people who lack capacity In line with the least restrictive principle in the MCA, Local Authorities and others drawing up plans must minimise planned restrictions and restraints on the person as much as possible. The MCA provides legal protection for acts of restraint only if the act is necessary to prevent harm to the person, a proportionate response to the likelihood of the person suffering harm and the seriousness of that harm, and in the person’s best interests. In DOLS cases, MCA/DOLS staff and the independent advocate must familiarise themselves with the provisions of the MCA, particularly the five principles and specifically the “least restrictive” principle. When designing and implementing new care and support plans for people lacking capacity, be alert to any restrictions and restraint which may be a degree or intensity that means a person is being, or is likely to be, deprived of their liberty. Where a potential deprivation of liberty is identified at the planning or commissioning care stage, a full exploration of the alternative ways of providing the care and/or treatment should be undertaken, in order to identify any less restrictive ways of providing that care which will avoid a deprivation of liberty; Where the plan for an individual lacking capacity will unavoidably result in a deprivation of liberty judged to be in the person’s best interests, this must be authorised before being implemented. If the person will be accommodated in a hospital or care home, the Local Authority can issue a deprivation of liberty authorisation under Schedule 1A to the MCA (DOL authorisation). If the person will be accommodated in other settings, a Court of Protection Order under the MCA to authorise the deprivation of liberty is needed. If the independent advocate is concerned that there is a risk of deprivation of liberty which has not been authorised, the advocate should raise this with the Local Authority. The advocate may make an application to the Court of Protection (with the Court’s permission) if they are dissatisfied with the Local Authority’s response. Combining plans Plans should not develop in isolation from other plans (such as plans of carers or family members, or Education, Health and Care plans) and should have regard to all of the person’s needs and outcomes when developing a plan, rather than just their care and support needs. The Local Authority should attempt to establish where other plans are present. Statutory Guidance Chapter 10 outlines circumstances where plans could or should be combined and the considerations to be taken into account in making the decision.

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Combined plans may be relevant where 2 people in the same household require care and support, or a care and support plan might be combined with that of a carer. Budgets as well as support plans can be combined. Combined plans should always represent the individual needs and circumstances of each person represented in the plan. Plans can combine and integrate the provisions of different agencies involved in the provision of an individual’s care and support plan for example with health for a person in receipt of s117 aftercare services or with housing departments involved in the persons support. Lead professionals can be appointed to ensure plans are aligned and to avoid confusion to the person to whom the plan relates. Sign-off and assurance The Local Authority must take all reasonable steps to agree with the person the manner in which the plan details how needs will be met, before the authority signs off the plan. Therefore, it should not introduce measures that place any undue burden on the person, especially where the person or third party is preparing the plan. Processes that undermine the joint preparation of plans, such as excessive quality control for example, should be avoided. The Local Authority must take all reasonable steps to reach agreement with the person for whom the plan is being prepared. Wherever possible, Local Authority sign-off should occur when the person, any third party involved in the preparation of the plan and the Local Authority have agreed on the factors within the plan, including the final personal budget amount (which may have been subject to change during the planning process), and how the needs in question will be met. This is a key part of the planning process and the agreement should be recorded and a copy placed within the plan. Where an independent advocate has been involved, they should not be asked to sign off the plan – this is the responsibility of the Local Authority. While there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion, proportionate to the needs to be met. The planning process should not unduly delay needs being met. Due regard should be taken to the use of approval panels in both the timeliness and bureaucracy of the planning and sign-off process. In some cases, panels may be an appropriate governance mechanism to sign-off large or unique personal budget allocations and/or plans. Where used, panels should be appropriately skilled and trained, and Local Authorities should refrain from creating or using panels that seek to amend planning decisions, micro-manage the planning process or are in place purely for financial reasons. In cases or circumstances where a panel is to be used, and where an expert assessor has been involved in the care and support journey, the same person or another person with similar expertise should be part of the panel to ensure decisions take into account complex or specialist issues. In the event that the plan cannot be agreed with the person, or any other person involved, the Local Authority should state the reasons for this and the steps which must be taken to ensure that the plan is signed-off. This may require going back to earlier elements of the planning process. People must not be left without support while a dispute is resolved. If a dispute still remains, and the Local Authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure.

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However, by conducting person-centred planning and ensuring genuine involvement throughout, this situation should be avoided. Upon completion of the plan, the Local Authority must give a copy of the final plan, which should be in a format that is accessible, to the person for whom the plan is intended and any other person they request to receive a copy, and their independent advocate if they have one and the person agrees. Reviews Overview Ensuring all people with a care and support plan, or support plan have the opportunity to reflect on what is working, what is not working and what might need to change is a an important part of the planning process. It ensures that plans are kept up to date and relevant to the person’s needs and aspirations, will provide confidence in the system, and mitigate the risk of people entering a crisis situation. The review process should be person-centred and outcomes focused, as well as accessible and proportionate to the needs to be met. The process must involve the person needing care and also the carer where feasible, and consideration must be given whether to involve an independent advocate if appropriate. The duty on the Local Authority therefore is to ensure that a review occurs, and if needed, that a revision follows this. Consideration should also be given to authorising others to conduct a review – this could include the person themselves or carer, a third party (such as a provider) or another professional, with the Local Authority adopting an assurance and sign-off approach. The review will help to identify if the person’s needs have changed and can in such circumstances lead to a reassessment. It should also identify other circumstances which may have changed, and follow safeguarding principles in ensuring that the person is not at risk of abuse or neglect. The review must not be used as a mechanism to arbitrarily reduce the level of a person’s personal budget. Where a review is being undertaken where a person has a carer, the Local Authority should consider whether the carer’s support plan requires reviewing as well. When a change to a plan is required but there has been no change in the levels of need (for example, a carer may change the times when they are available to support), or there are small changes in need, then these can be accommodated within the established personal budget. In these circumstances, it may not be appropriate for the person to go through a full review and revision of the plan. The Local Authority should respond to these ‘light-touch’ requests in a proportionate and reasonable way. Where the Local Authority is satisfied that a revision is necessary, it must work through the assessment and care planning processes to the extent that it thinks appropriate. Where a plan is for a person with mental health problems, this section should be read in conjunction with the Mental Health Act 1983 Code of Practice (on the Care Programme Approach) and Refocusing the Care Programme Approach.

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Review of the care and support plan The Act specifies that plans must be kept under review generally. Therefore the council and commissioned providers should establish systems that allow the proportionate monitoring of both care and support plans and support plans to ensure that needs are continuing to be met. This system should also include seeking cooperation with other health and care professionals who may be able to inform the authority of any concerns about the ability of the plan to meet needs. The review process should not be overly-complex or bureaucratic, and should cover the following broad elements:

Have the person’s circumstances and/or care and support or support needs changed?

What is working in the plan, what is not working, and what might need to change?

Have the outcomes identified in the plan been achieved or not?

Does the person have new outcomes they want to meet?

Could improvements be made to achieve better outcomes?

Is the person’s personal budget enabling them to meet their needs and the outcomes identified in their plan, and

Is the current method of managing it still the best one for what they want to achieve, e.g. should direct payments be considered?

Is the personal budget still meeting the sufficiency test?

Are there any changes in the person’s informal and community support networks which might impact negatively or positively on the plan?

Has there been any changes to the person’s needs or circumstances which might mean they are at risk of abuse or neglect?

Is the person, carer, independent advocate satisfied with the plan? Types of Review A review may be a planned review (the date for which was set with the individual during care and support planning, or through general monitoring) or an unplanned review (which results from a change in needs or circumstance that the Local Authority becomes aware of, e.g. a fall or hospital admission); or a requested review (where the person with the care and support or support plan, or their carer, family member, advocate or other interested party makes a request that a review is conducted. This may also be as the result of a change in needs or circumstances). Planned reviews During the planning process, the person and their social worker, or relevant professional may have recorded a review date in the plan. Even in cases with anticipated review dates, this should not reduce the requirement to keep the plan under review generally. The first planned review should be an initial ‘light-touch’ review of the planning arrangements 6-8 weeks after sign-off of the personal budget and plan. Where relevant, this should also be combined with an initial review of direct payment arrangements. In addition, where plans are combined with other plans (for example the plan of a carer, or a health and care plans which may be reviewed annually) the Local Authority should be aware of the review arrangements with these other plans and seek to align reviews together.

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Planned reviews should be proportionate to the circumstances, the value of the personal budget and any risks identified. There should be a range of review options available, which may include self-review, peer led review, reviews conducted remotely, or face to-face reviews with a social worker or other relevant professional. This does not preclude the person requesting a review at another time or a face to face review being needed if there is an unplanned change in needs or circumstances. In all instances, the method of review should wherever reasonably possible be agreed with the person and must involve the adult to whom the plan relates, any carer the adult has and any person the adult asks the authority to involve. An independent advocate should be provided as appropriate where this is required by the circumstances specified in the Act. If a person is recorded as having a mental impairment and lacking capacity to make some decisions, then the Local Authority should consider carefully when it will be appropriate for the next review to take place. In these instances, making appropriate use of a social worker as the lead professional should be encouraged. Where conditions are progressive, and the person’s health is deteriorating, reviews may need to be much more frequent. Similarly where a person has few or no family members or friends involved in supporting them, the risks are higher, and again reviews or monitoring may need to be more frequent. It may beneficial to put a ‘duty to request a review’ into commissioned services so that employees are required to inform the Local Authority if they think that there is a need for a review. Unplanned reviews Where circumstances have changed in a way that may affect the efficacy, appropriateness or content of the plan, then there should be an immediate review to ascertain whether the plan requires revision. For example this could be where a carer is no longer able to provide the same level of care, there is evidence of a deterioration of the person’s physical or mental wellbeing or the Local Authority receives a safeguarding alert. During the review process, the person the plan is intended for, or the person acting on their behalf should be kept fully involved and informed of what is occurring, the timescales involved and any likely consequences. This will help to alleviate anxiety at a time where things in the person’s life may have changed substantially. Considering a request for a review of a plan

In addition to the duty on Local Authorities to keep plans under review generally, the Act provides a duty on the Local Authority to conduct a review if a request for one is made by the adult or a person acting on the adult’s behalf. People should provide information and advice to people at the planning stage about how to make a request for a review. This process should be accessible and include multiple routes to make a request – phone, email, text for example. The information given to people should also set out what happens after a request is made, and the timescales involved in the process. The right to request a review applies not just to the person receiving the care, but to others supporting them or interested in their wellbeing. Considering a review

Upon receipt of a request to conduct a review, the Local Authority must consider and judge the merits of conducting a review. In most cases, it is the expectation that a review should

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be performed unless the authority is reasonably satisfied that the plan remains sufficient, or the request is frivolous, or is made on the basis of inaccurate information, or is a complaint; for example where a person lodges multiple requests for a review in a short period of time and there is no reason to believe that the person’s needs have changed. In considering whether to undertake a review the authority must involve the person, carer and anyone else the person requests to be involved where feasible. The Local Authority will need to identify those who may have significant difficulty in being fully involved in the decision to review and when there is no appropriate person who can represent or support their involvement and consider the duty to provide independent advocacy. A similar provision exists in the Children & Families Act, where those with education, health and care (EHC) plans have a right to request a review of their EHC plan (as can others on their behalf). This will include any adult care components set out in the plan. Where a decision is made not to conduct a review following a request, the reasons for not accepting the request should be given in a format accessible to the person, along with details of how to pursue the matter if the person remains unsatisfied. In most cases, it would be helpful for this to set out that the authority will continue to monitor the plan to ensure that it remains fit for purpose, and that the decision does not affect the right to make a future request for review. Revision of the care & support plan Where a decision has been made following a review that a revision is necessary, the authority should inform the person, or a person acting on their behalf of the decision and what this will involve. Where the person has substantial difficulty in being actively involved with the review, and where there are no family or friends to help them being engaged, an independent advocate must be involved. When revising the plan the Local Authority must involve the person, their carer and any other persons the adult may want involved, and their advocate where the person qualifies for one. The Local Authority must take all reasonable steps to agree the revision. The revision should wherever possible follow the process used in the assessment and care planning stages. Indeed, the Local Authority must if satisfied that the circumstances have changed in a way that affects a care and support or support plan, carry out a needs or carer’s assessment and financial assessment, and then revise the plan and personal budget accordingly. The assessment process following a review should not start from the beginning of the process but pick up from what is already known about the person and should be proportionate. In some cases a complete change of the plan may be required, whereas in others minor adjustments may be needed. In either case, the following aspects of care planning should be followed:

the person’s wishes and feelings should be identified as far as possible and they should be supported to be involved;

the revision should be proportionate to the needs to be met;

where the plan was produced in combination with other plans, this should be considered at the revision stage;

the person, carer or person acting on their behalf should be allowed to self-plan in conjunction with the Local Authority where appropriate;

the development of the revised plan must be made with the involvement of the adult/carer, and any person the adult asks the authority to involve;

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any additional elements that were incorporated into the original plan should be replicated in the revised plan where appropriate and agreed by all parties;

and there needs to be clarity on the sign-off process, especially where the revised plan is prepared by the person and the Local Authority.

Particular attention should be taken if the revisions to the plan proposes increased restraints or restrictions on a person who has not got the capacity to agree them. This may become a deprivation of liberty, which requires appropriate safeguards to be in place. The Local Authority must consider in all cases whether an independent advocate may be required to facilitate the person’s involvement in the revision of the plan. Where the plan was produced with the assistance of an independent advocate, then consideration should be given to whether an independent advocate is also required for the revision of the plan. In these scenarios, the advocate would ideally be the same person to ensure consistency and continuity with the case details. Likewise, where a specialist assessor has been used previously in the care and support journey, the Local Authority should have regard whether they need to employ the expertise of the assessor in the review. Timeliness and regularity of reviews

In the absence of any request of a review, or any indication that circumstances may have changed, the Local Authority should conduct a periodic review of plan. As stated earlier, this could be indicated at the planning stage by including an anticipated review date. It is the expectation that authorities should conduct a review of the plan no later than every 12 months, although a light- touch review should be considered 6–8 weeks after agreement and sign-off of the plan and personal budget, to ensure that the arrangements are accurate and there are no initial issues to be aware of. This light-touch review should also be considered after revision of an existing plan to ensure that the new plan is working as intended, and in cases where a person chooses a direct payment, should be aligned with the review of the making of the direct payment (6 monthly requirement). Periodic reviews and reviews in general must not be used to arbitrarily reduce a care and support package. Such behaviour would be unlawful under the Act as the personal budget must always be an amount appropriate to meet the person’s needs. Any reduction to a personal budget should be the result of a change in need or circumstance. Self Funders The Care Act requires that adults with an appearance of need for care and support, or carers with an appearance of need for support are assessed regardless of the Local Authorities’ view of their finances. The assessment should be followed by a determination of which of their assessed needs are eligible to be met by the Local Authority and which are non-eligible. Only then should a financial assessment be undertaken along with an ordinary resident test. People who are funding their own care, and are ordinarily resident in the authority’s area have the right to ask the Local Authority to meet their eligible needs in which case the support plan should set out assessed needs including eligible and non-eligible needs and how these are to be paid and charged for. These situations may include where there are no relatives or friends willing to help, arranging care and support in the same way we do for those who we fund.

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The County Council will be required, as part of the implementation of Part 2 of the Act from 1st April 2016, to put arrangements in place with regard to the Care Cap and Independent Personal budgets. The care cap will limit care costs which a person pays in their lifetime. The cap that applies to a person depends on their age:

For people over retirement age, this cap is set at £72,000.

The cap for working adults has not currently been set but will be confirmed prior to April 2016.

Children who turn eighteen with eligible needs will not have to pay for their eligible care costs.

The cap on care costs only covers what it would cost the Local Authority to meet the person’s eligible needs. Examples of costs that would not count as progress towards the care cap include:

‘Hotel costs’ or the non-care, general residence element of the cost charged by care homes. This is assumed by central government to amount to £12,000 per year.

Any additional amounts that the person might want to pay to move into a residential home of their preference, over the cost of the Local Authority’s recommended residential home.

Once the cap is reached, the Local Authority will pay for the person’s eligible care, excluding the hotel costs and any additional payments that the person has chosen to make. In order for progress towards the care cap to be monitored, the person in need of care will require a needs assessment and a financial assessment. Statutory guidance for Part 2 of the Care Act is awaited to confirm the approach to be taken with regard to the care cap and other related provisions. It is highly recommended that independent financial advice is sought by any person starting to plan for their future care needs. Consultation, Approval and Ratification Process No consultation required as this policy reflects regulations and statutory guidance Dissemination and Implementation Dissemination This policy will be published internally electronically, via the intranet and policy databases and communicated to external stakeholders. Implementation The policy identifies the date of implementation and training and awareness will be provided to ensure a successful implementation.

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Monitoring Compliance Audit processes will be used to ensure operational staff are providing care and support in light of this policy and as legislation and guidance requires.

References and Supporting Documents References

Care Act Regulations and Statutory Guidance 2014

Mental Capacity Act 2005 Policy Review This policy will be reviewed two years following ratification or sooner if the necessity arises.

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Appendices Appendix 1 The assessment pathway