Department of Health
Published: 22 May, 2014
guidance on care and support plans
guidance on the review of care and support plans
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10.67.Consideration should be given in showing the key points of the care-plan to other professionals and supporters with the person’s consent.
Qu 50. A person may lack capacity and may not give consent. If this is the case it does not help a main relative carer.
I am a carer representative for a Supported Housing organisation and have had Mothers of a person with mental illnes who are not updated with the care plan but subsequently hear their offspring’s mental health is deteriorating. They are extremely distressed because they would like to have input to the care planning of their loved ones but they are prevented because when a person’s mental health is deteriorating they are less likely to give consent to help.
The guidance is not written as practice guidance and has a much wider audience than care and support workers. The only reference to training and development we could see in this chapter was paragraph 10.22 about developing the workforce to adopt an asset based approach. There is a long term development agenda to create a workforce ‘fit for Care Act purpose’ and to embrace personalisation which should be acknowledged in the guidance. We would like to see the definition of workforce extended to include supported housing. Sitra has very recently undertaken a project for Skills for Care on workforce issues in Extra Care Housing which might usefully be mentioned as a forthcoming report.
The research carried out by Sitra on behalf of Skills for Care has focussed on the workforce requirements of the Extra Care Housing sector. The changing responsibilities resulting from the introduction of the Care Act were a priority for managers and stakeholders, and therefore it is critical that the broader workforce is considered within local authority plans. The research highlights the importance of integration between housing, health and social care within workforce development approaches and provides evidence that workforce development needs to support organisations ad staff to provide a breadth of knowledge to people. There was also recognition that any support provision needs to encompass all operational levels of staff and a wide range of roles.
Again there are some good links at the end of the advice especially the HSA. However it would be helpful to extend these. Identifying the aspirations of a client is in some circumstances very difficult. There are helpful group processes which encourage circles of support, planning alternative futures with hope etc. which should also receive links.
further more the Occupational Therapy services with dead lines for provision etc. should be spelled out in the guidance.
The Care Act 2014 draft aims to integrate (and rescind) several acts of parliament where local authority statutory services have a duty to assess the needs of people with long term illnesses & physical impairments and arrange for services to be provided (including information, advice and guidance). The act also places duties on the local authority to assess the needs of carers and arrange services for all needs (including information, advice and guidance).
The gaps I have identified relate to “the role of community Occupational Therapists OT” in the RAPS process (equipment and adaptations work stream; as opposed to the reablement workstream). The government/DH should capture the following in the customer journey as part of a Adult Social Care Outcome Framework as the demand for service pull on the limited Occupational Therapy resource within every local authority (or delegated provider organisation) service. The following lines (as performance/outcome indicators) would enable the government/DH to assess the impact of risk (such community related deaths as a result of poor response time for OT assessments or avert the claim of contributory negligence as a result of increased likelihood of pressure sores due to a delay in the assessment/provision of suitable moving and handling equipment.
OT Referral & OT Initial Interview and OT Initial Assessment
People are referred to the service and are provided an initial contact assessment by customer call centre professionals. The outcome of the assessment should be advised about options to privately purchase bath lifts. A high percentage of people can keep hygienically clean using a strip wash when they cannot climb into and out of a bath. Level access shower facilities as OT recommendations should be a recommendation for people who are incontinent and suffer with neurological conditions which result in paralysis. Currently many outlets in a range of communities sell bath lifts in a retail capacity (e.g. B&Q).
Where direct requests for majors adaptations are made to the customer call centre – people should prove that they have been turned down for a bank loan in the last 12 months and provide evidence of three competitive estimates from builders regarding the building specification that they are requesting.
People should also be offered a self assessment for several options a. Equipment b. Minor Adaptations c. Major Adaptations. The government should have a baseline of what they expect from each authority for this option.
The equipment or adaptations assessment is recorded to take place within a statutory timescale of 30 days (including the offer of a self assessment – which can be a letter from the client ; advocate such as Age UK Charity or private OT).
Where people are in working age – with the condition of low level pathology (such as back pain controlled by medication) and unemployed then day time occupational interests/hobbies should be linked directly to the department of work and pensions job seekers allowance team. Client should be encouraged to seek gainful employment.
Percentage of all high risk (e.g. moving and handling; end of life adaptations; assessments for people needing equipment in day centres; people needing equipment in residential homes; out of area hospital discharges; void property assessments) cases should mimic the social care timescales for assessments to take place within 28 days of assessment (at the moment this data is not tracked by central government).
Provision of services and Review of services
Percentage of clients who have received a major adaptation that have remained at home 12 months after the completion of the major adaptation. The assumption to test is that OT intervention can enable people to remain at home as opposed to being transferred into a care home at a longer term cost to the state.
The review of OT services should be a specific wellbeing outcome as a result of the a. Minor Adaptation, b. Equipment, c. Major Adaptation.
To better assist care and support workers to do their job effectively, the drafting of the guidance would benefit from greater clarity at certain points and a number of specific suggestions can be found below. The use of more relevant case examples is also greatly needed to illustrate what proportionate planning looks like. In our view, the existing example provided at paragraph 10.25 of the draft guidance is unhelpful as fluctuating needs are a completely different matter
Suggested adjustments to the Care and Support Plan draft guidance
1. Use of people nominated by the person to involve him/her in the planning process
At present, the guidance begs the question of what should happen if the nominated person is unable to effectively facilitate involvement (e.g. because they have no knowledge of social care law or local procedures). If the solution is an independent advocate, does that advocate replace the nominated person, work with them or is there another solution?
2. Light touch vs Proportionate planning
The draft guidance states that light touch and proportionate planning are not the same thing. However, it is far from clear that this is the case and clarification is needed. It should be noted that it will not be possible for local authorities to exercise light touch assessments and planning as we will need to robustly assure the meeting of eligibility for care and support services given limited resources.
3. Minimising and authorising deprivation of liberty (DOL) for people who lack capacity
We are not convinced that the draft guidance can usefully comment on DOL given the fast-changing pace of the law since the Cheshire West Judgement. We would also comment with reference to 10.51 that ‘ MCA/DOLS teams’ may not exist in that format within all local authorities.
4. Sign-off and assurance
We believe that the third sentence of paragraph 10.61 sets up a potential conflict between local authorities and service users and should be deleted.
To better assist care and support workers to do their job effectively, the drafting of the guidance would benefit from greater clarity at certain points and a number of specific suggestions can be found at Annex A. The use of more relevant case examples is also greatly needed to illustrate what proportionate planning looks like. In our view, the existing example provided at paragraph 10.25 of the draft guidance is unhelpful as fluctuating needs are a completely different matter
The care and support plan MUST be written jointly with the Care Manager and either the disabled person and/or family members or deputies or people holding power of attorney. the plan MUST be written in a timely manner (state 2 weeks or 4 weeks) then the Care Manager goes back to the family with the completed plan it is checked and verified by everyone and signed on to be everyone it should not be just posted off and expected to arrive and no discussion about any errors/problems with it.
There are a lot of people that will believe/allow the council to do just what they say a very basic ill informed document that provides little data on the disabled person and little work for the council – we have a suite of documents produced by us all needed for our sons care but the council are not interested in it at all but do refer out to it from the Care Plan surely when a Care Plan makes reference to a document then the council should have a copy and be able to refer to it themselves.
should there not be in there Care Act some protection for the carers as they are deemed as legally being entitled to being supported in their demanding roles and the councils must know that they are doing this difficult role yet continue to do nothing until the cries for help or complaints reach a certain level we are both carers for our disabled son and our care manager said he would organise a carers assessment 4 years ago it was only in march 2014 that we actually saw someone and started the ball rolling the carers assessment has now been completed and was sent to our new care manager who we are informed this week is no longer our care manager so we do not have one at all and a new one will be allocated in September to our family meanwhile it appears no one is dealing with our carers assessment. For the past 4 years we should have been receiving some additional support to assist us in our roles as carers but have had nothing THE COUNCIL DO NOT APPEAR TO HAVE ANY TIMESCALES TO STICK TO PERHAPS THEY SHOULD THEN FAMILIES WILL NOT BE LEFT TO GET ON WITH THINGS UNTIL THEY REACH CRISIS POINT WHICH IS NOT GOOD FOR ANYONE.
There is a continuing problem with finding anyone with any knowledge in autism never mind specialist training in autism we keep meeting with people and they do not have a clue yet the autism act places statutory obligations on councils to meet the needs of the autistic adults in their area. Autism is a very complex condition and councils are not giving families the right support/help. Where are all of these people that are supposed to exist with their specialist training to help us surely the CARE ACT should be including this detail.
Also reading through this section and coming across capacity, diminished capacity, best interests etc I did not come across any mention of Power of Attorney or Deputyship. We got totally fed up with our son having to be re-assessed every single time doe she still have diminished capacity so we applied to the Court of Protection and obtained Deputyship for heath welfare and finance and now all of that hassle has disappeared, we can legally speak for and assist our son regarding most things and do not have to wait for the council to decide yet again that his is still severely autistic and still has diminished capacity which quite honestly is heart wrenching every time it comes up.
having read through the care and support planning process as it is supposed to be done and understanding that similar guidance would have been in place before the care act 2014 I feel that the details and instruction and not forceful enough. Having read all the details within the Care Act 2014 i feel it is very important for someones specific problems/needs/routines etc to be amply detailed in the document.
It appears that where it is written that care plans should not be so detailed as to restrict the disabled person (that is the essence of the statement) the councils have used this to basically save on time and effort and tell us all that the plan needs very little details in it. so in trying to assist the disabled person we have failed in that the councils are not bothering to complete the care plan with the information that should be there.
Partially – With an emphasis on peer/community support to deliver care and support you run the risk of bias/influence from untrained people – this approach needs to be treated with caution – not sure if this would fully support a truly personalised approach.
Glad to see carers referenced throughout – Care Act should help carers to ask how care will be delivered and call people to account
Partially – Personal budgets don’t sit well with people living in residential care – personalisation is good – the difficulty is paying for it when you are in residential care in particular
There should be more emphasis on linkages to voluntary and faith groups
Partially but access to truly independent advocacy is important as SU’s and carers can have different views – the emphasis on Advocacy throughout the Act is welcomed
More robust legislation/guidance is needed on Carers right to assessment particularly in CHC unless the law firms up on this carers will routinely get missed out from health care assessments
Section 75 – commissioning and staff resources aren’t in place to support carers now – cant see how this is this being address through the Act?
For Older carers there is a continuing issue of co-dependency – of the carers and cared for.
Would like to have seen something that recognises/takes account of “mutual caring”
Partially agree that it does – would help if Care Coordinator jobs are formalised and Government firmed up and took control in enforcing more robust referral pathways esp. around hospital discharge
Does not take account of people with LD in residential care homes – in particular personal budgets – covering activity and/or support – usually one or the other – is this truly personalisation ?
The spirit of the Act/way in which it is written seems to be still “top down” – there should be more emphasis on choice and control
Not really – people with mental health needs need longevity in a relationship with their support networks – cant see anything in the Act that support that
Partially – person centred care and support should encompass personal safety – there’s not much mention of that in the Act
There is a positive emphasis on choice and options for people and does move in the right direction but will it translate into truly personalised solutions for people because of funding issues?
You don’t realise you need help until sometime too late – that’s why it’s good to see Advocacy services and skilled workers to help people
Beware using peer support for Advocacy – you run the risk of bias – to be truly effective you need independent advocacy which should be adequately resourced. – consensus
Its positive that the care act emphasises that carers should drive how care is delivered although there is nothing that gives carers comfort that carers assessments will be carried out. – We would like to see the law firmed up on carers rights to assessment particularly within CHC
Its positive that carers can make authorities accountable asking how care will be delivered
Not convinced what’s written will make a difference – re- section 75 – it’s a fact that commissioning and staff resources are not in place to support carers
Whole family assessments are good but shouldn’t be to the detriment of family member
The current guidance needs to be strengthened to support both workers and citizens to understand how this is intended to be implemented. Inclusion of examples or scenario’s which cover responsibility for confirming and signing off assessments and budgets need to be clearly show that the Local Authority will be responsible for this. This will clarify the guidance and process which will support workers in practice and citizens in understanding the process. The current guidance appears vague and could be misconstrued as offering the service user the ability to self-assess without the Local Authority being involved. Whereas it later states that the assessor would play a key role in assessment and eligibility for any funding. The focus on empowerment is a positive one, however the roles of citizen and worker need to be clearly stated to avoid unnecessary misunderstanding.
The guidance sets out the expectations and it is clear that that for many that inherent change will be needed as to their mode of practice across all sectors of the care industry.
Until Local Authorities sign up to outcome focussed commissioning in reality as well as in their rhetoric then service users will never be in a position to influence and be in control of their support. Care and support workers would be able to work more closely with service users and achieve better outcomes if time to task approaches were finally ended.
minimum standards of qualifications in all aspects of care should be specified
LD, Autism, Complex needs etc.
I would hope that sufficient resources would be put in place (i.e. More trained social workers/needs assessors) so that the initial “needs assessment” is seen less as a one-off, and more as a process. This would require multiple ongoing interactions between the assessor and person + carer. This would overcome some of the issues about how long to assess needs for when a person has fluctuating needs, and would allow people who are not sufficiently articulate at the initial needs assessment to feed back on whether the support they are receiving is actually meeting their needs and promoting their well-being. It may also allow issues about abuse and inadequate services from new outside providers to come to light.
I’m not sure the guidance fully allows a proportionate response as There is perhaps a tension inherent in the notion of a simple need and a simple solution against and trained professional assessing and an appeal that can challenge a decision. The proportionate approach is absolutely right and there is a need to then ensure that the rest of the guidance and the processes/systems that back this up, including appeals, is also proportionate and does not lead workers into following a full assessment course in order to be able to justify their decision if challenged, particularly if this an empowered service user decision. The principle of meeting well-being need also is broad and can lead to wider interpretation and potentially greater challenge.