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https://www.legislation.gov.uk/ukpga/2002/7/contents

https://commonslibrary.parliament.uk/research-briefings/cbp-7698/

https://england.shelter.org.uk/professional_resources

https://www.crisis.org.uk/media/1013/impactreport_2015_final_low-res_spreads.pdf

https://england.shelter.org.uk/housing_advice/homelessness

http://www.nosecondnightout.org.uk/protocols-and-guidelines/

https://stmartinshousing.org.uk/how-we-help/our-services/roofless/outreach-and-advice/

https://www.homeless.org.uk/

https://www.solohousing.org/information-and-advice/for-residents/

https://www.local.gov.uk/our-support/coronavirus-information-councils/covid-19-service-information/covid-19-housing-planning

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https://www.socialworkengland.org.uk/education-training/information-for-providers/approved-mental-health-professional-amhp-courses/

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https://www.basw.co.uk/system/files/resources/BASW%20AGM%20NRPF%20Presentation%2013%20%206%2019.pdf

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This video for social care commissioners and staff shows people with experience of personalised services describing the impact that personalisation has had on their lives. It also looks at what personalisation means for social care workers.

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Social Care Institute for Excellence (SCIE)

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Published: March 2015

Key messages

The Care Act 2014 requires local authorities to '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' in considering 'what else other than the provision of care and support might assist the person in meeting the outcomes they want to achieve'. In order to do this the assessor 'should lead to an approach that looks at a person's life holistically, considering their needs in the context of their skills, ambitions, and priorities'.

Local authorities should identify the individual's strengths - personal, community and social networks - and maximise those strengths to enable them to achieve their desired outcomes, thereby meeting their needs and improving or maintaining their wellbeing.

Any suggestion that support could be available from family and friends should be considered in the light of their appropriateness, willingness and ability to provide any additional support and the impact on them of doing so. This is also subject to the agreement of the adult or carer in question (see 6.64 of the Care Act guidance).

The implementation of a strengths-based approach within the care and support system requires cultural and organisational commitment beyond frontline practice. Practitioners will need time for research and familiarisation with community resources. Accountability has to be with the practitioner and time has to be allowed for the assessment to be undertaken appropriately and proportionately.

The objective of the strengths-based approach is to protect the individual's independence, resilience, ability to make choices and wellbeing. Supporting the person's strengths can help address needs (whether or not they are eligible) for support in a way that allows the person to lead, and be in control of, an ordinary and independent day-to-day life as much as possible. It may also help delay the development of further needs.

What is a strengths-based approach to care?

Strengths-based practice is a collaborative process between the person supported by services and those supporting them, allowing them to work together to determine an outcome that draws on the person's strengths and assets.

A strengths-based approach to care, support and inclusion says let's look first at what people can do with their skills and their resources and what can the people around them do in their relationships and their communities. People need to be seen as more than just their care needs - they need to be experts and in charge of their own lives.
Alex Fox, chief executive of the charity Shared Lives

The phrases 'strengths-based approach' and 'asset-based approach' are often used interchangeably. The term 'strength' refers to different elements that help or enable the individual to deal with challenges in life in general and in meeting their needs and achieving their desired outcomes in particular. These elements include:

their personal resources, abilities, skills, knowledge, potential, etc.

their social network and its resources, abilities, skills, etc.

community resources, also known as 'social capital' and/or 'universal resources'.

What do practitioners need to consider?

Practitioners will need to work in collaboration with service users, supporting them to do things for themselves, with the aim that they become more than passive recipients of care and support. In order to do this, it is fundamental that practitioners establish and acknowledge the capacity, skills, knowledge, network and potential of both the individual and the local community.

Preparing for assessment

Preparing for an assessment is key to ensuring the intervention is conducted professionally, that its effects are maximised and that the assessment is both appropriate and proportionate. When preparing for an assessment you should:

Gather information and background on the individual's circumstances:

What are their reasons for contacting social services?

Are there any other professionals involved?

Do the local authority or any partner organisations have any useful background information?

Is an interpreter or advocate needed?

Determine, jointly with the individual, how the assessment will be conducted in terms of appropriateness and proportionality. See the SCIE Guide, 'Ensuring assessment is appropriate and proportionate':

Has the individual been informed about what an assessment involves: their options, the timescales, the potential next steps?

Does the individual prefer to perform a supported self-assessment? See the SCIE Guide, 'Supported self-assessment'

Agree on who should contribute to the assessment other than the individual and how this will be done.

If an assessment visit is to take place:

Has everybody who needs to be there been informed (i.e. care professionals, carers, other family members, friends, etc.)? Have they confirmed their attendance?

Do you have all the information and paperwork you need?

Have you done research on related community services, products and activities?

What information is being sought?

The assessment intervention should aim to discover what the person concerned believes would constitute a 'good life' for them and their family, and how all parties can work together to achieve this.

In particular the following information should be gathered using open questions rather than a tick-box exercise. The following questions are examples of the type of information that may need to be gathered, although each assessment should be approached on a case-by-case basis, and it may not be necessary or relevant to ask all of the questions suggested here.

Individual's strengths, hobbies, abilities, wishes, etc.

What is the individual good at? What do they enjoy doing? What did they used to enjoy doing but can no longer do?

What would they like to be better at?

What do they think they can do better or more of?

What do they think they can do to improve themselves and their wellbeing?

What do they think will help, if not to make things better, then at least to prevent things from getting worse?

Individual's support network (friends, family, neighbours, professionals, etc.), their strengths, abilities, knowledge, etc.

Who can they count on? How would they reach them? What would they count on them for?

Who visits them frequently? How often?

Who do they miss? Why are they not able to see/keep in touch with these people?

Who do they communicate with? How? With what frequency?

Who else do they know that could be part of their lives?

Are there any other people helping the individual? Any other professionals?

Is there anything that could facilitate this network to increase, either in quantity or quality? Do they want it to increase?

What has been working until now, and how have things changed?

What could help to enable them to return to previous means of support which worked for them?

Which needs/outcomes can be met/achieved now without waiting for/moving to a care and support plan?

Needs, challenges, risks, etc. (focusing on strengths does not mean ignoring these, but maximising and using the strengths to overcome them)

What is preventing the individual from doing what they would like to do or seeing who they would like to see?

What do they think they can do to change this?

Who do they think can help to change it?

Practitioners should ensure that they have fully and accurately understood the individual's views on the above, and ask for clarification when required. 'Presenting back' to the individual is a good technique for confirming the accuracy of information. For example: 'So what I heard you say is ...'; 'Can I check I've understood this as you meant it ...'.

It is easy to misunderstand what others say, or to only understand it within our own context. When people talk about things they are very familiar with, they often omit information that could be key to understanding fully and accurately what they mean. Practitioners should ensure as far as possible that no information is missing or misunderstood.

Example 1: ease of misunderstanding

Mrs J, a woman who lives on her own, is introverted and has never had any relationship with her neighbours. However, she says that her relationship with them is 'good'. For her, this means that they never bother her and she has no interaction with them at all. However, the assessor may understand 'good' to mean that the neighbours are helpful and that Mrs J could call on them if she was in need of help.

Strengths-mapping

A focused discussion with the person about their strengths can lead to new opportunities to develop and share skills and make new connections. This is sometimes referred to as a 'strengths-mapping exercise'. This method of assessment builds a picture of the individual's strengths and of the community around them. There are two types of strength: 'soft' and 'hard', each of which applies to the individual and the community.

'Soft' strengths
Individual

Personal qualities

Knowledge and skills

Relationships

Passions and interests

Community

Links with neighbours

Community groups

Shared interest groups

Community leaders

'Hard' strengths
Individual

Health

Finances

Housing

Transport

Community

Health and social care services

Leisure

Schools

Community buildings

During the assessment it may be helpful to consider the following questions: [ 3]

In order to remain as independent as possible, what strengths (knowledge, experience or expertise) does the individual already have and how could these be enhanced?

In order to enable an individual to remain as independent as possible, what other skills, knowledge, experience or expertise do people directly or indirectly involved in the person's life already have or need to acquire?

It is also important for the practitioner to have an objective understanding of the individual's views and to ensure that strengths, needs and outcomes have not been over- or underestimated. In order to do this, it may be necessary to speak to others in the individual's network (ensuring consent is obtained) and/or seek evidence. For example, it may mean observing or establishing via others an individual's level of mobility. They may have been living with severely reduced mobility over a long period and become accustomed to the considerable limitations this causes them in their day-to-day life, while an objective understanding gained during assessment would help to reveal the true impact on the individual's wellbeing.

Example 2: a balancing act

Ms L, 85, is asking for help as she can no longer safely manage her own personal care. During the assessment it emerges that Mrs T, a friend who lives nearby, and who has been providing support until now, including personal care, has suggested that she might not want to continue in future. With Ms L's permission the assessor talks to Mrs T and discovers that she would in fact be happy to continue if she can be assured that she is doing the right thing and that she would not be expected to do any more if and when the situation changes.

During the discussion it emerges that Mrs T is interested in the option of sharing the provision of support with the local authority. This would allay her concerns about Ms L's potentially increasing needs, and access to her own support and/or training, along with and further guidance on her caring role, would reassure her that she is 'doing the right thing'.

It is important in this case for the assessor to explore Ms L's own view concerning her personal dignity: how does she feel about relying on informal help from someone she knows as opposed to receiving help from a 'stranger' from social services? How does she feel about a 'balance' of care, as discussed with Mrs T?

The assessor should also ensure that relevant benefits are claimed, such as attendance allowance, which, if appropriate, could be used to pay for informal support. This may in turn help in maintaining Ms L's dignity by giving her greater control.

What makes a good assessment?

At SCIE we asked a group of people using and receiving services, and a group of carers, to share their experiences of being assessed, and tell us what a social worker could do to make an assessment better. Their answers highlighted the following areas.

Be flexible and perceptive of an individual's situation and needs around the assessment process.

Allow for a break in the assessment if needed so that the user doesn't become overwhelmed.

Have an understanding of the person's condition.

Repeat facts to confirm they're accurate and you have noted them down correctly.

Follow a holistic/whole-person approach.

Look at the whole community and be aware of the support available from that community.

Focus on a whole-life approach not just a person's care needs.

Focus on outcomes.

Consider how the individual might contribute to the local community, and hence be better integrated in the wider society around them.

Be professional, honest, open and approachable.

Make sure you listen.

Let people speak, even if their assessment is taking place with an advocate present.

Be clear that you can't fix everything in one session and that this is an ongoing process.

Build trust with people.

Be conversational without too much direct questioning - people will open up more and provide more detailed answers.

Be friendly but be aware of the difference between 'friend' and 'friendly'.

Be clear about who is making any given decision. If you need to take your findings to your manager then be clear about this from the start.

Let the individual know that they have a right to appeal against the outcome of the assessment.

Explain the possible outcomes

Don't use jargon.

Perform your assessment as an intervention, so that the individual will benefit from the process itself no matter what the outcome is.

What happens next? Extending a strengths-based approach from assessments to meeting needs

A local authority can extend the use of the strengths-based approach from assessments to meeting needs. Having identified the person's strengths and resources in the assessment, the assessor will need to consider how these can be deployed at the care and support planning stage in a sustainable way. It may help to think about how the person currently engages with the community and in what way, by mapping their existing contacts, as shown in the diagram below.

Mapping the person's existing contacts helps to build an understanding of the people and organisations they already interact with and may trust. A person's confidence is a necessary prerequisite for adopting a strengths-based approach to meeting needs. In order for this approach to be possible and sustainable, the assessor will need to consider whether the person has the necessary strengths, has the capacity to learn and change their way of doing things, and trusts the networks that they will be relying on. It is vital that the person is empowered and is reasonably determined to make things work.

The strengths-based approach can them proceed via:

1. Identification of the person's strengths and capacity as well as their current interactions with the community (as illustrated above) in the assessment.

2. Building strengths-based interventions around the person's outcomes and aspirations identified in the assessment at the care and support planning stage. The strengths-based approach lends itself well to needs related to connecting with people, staying (physically) active, socialising, learning new skills and/or offering skills or knowledge to others in the community. When the strengths-based approach is executed well, informal networks can be utilised to meet the more practical needs of the individual. This is why it's important that the person's networks are identified in the assessment.

3. Finding solutions in the community or social environment at the care and support planning stage. In order for this to be possible, the community needs to be seen as resource-rich. It may help to think of resources in terms of actual support services, informal support with care tasks, time, finances, information, advice or knowledge.

These three steps show how the assessor, the commissioner and the care manager need to work together. The assessor needs to identify strengths, harness these to achieve positive change and build support relationships that can make the intervention planned by the commissioner sustainable.

Finding solutions in the community may appear to be a daunting task. For a local authority to reap the benefits of a strengths-based approach, it may help to think of it not as a task, done just for the given individual, but as a strategy that is pursued for the benefit of everyone who approaches the local authority and for the benefit of the wider community. There are a number of ways for assessors, commissioners and care managers to establish community strengths and resources, and two examples follow: local area coordination and community strengths-mapping.

Local area coordination

Local area coordination is an approach to assisting local people (including those with care and support needs) to build their personal or family vision and take action for a good life by supporting them to stay strong, safe and connected. With a focus on strengths, aspirations and contributions, the person or family are empowered to build and sustain their networks locally, thus nurturing resilience and independence.

Local area coordinators work in defined communities to support the building of strong local relationships and contribute to sustainable, inclusive and supportive communities. They support individuals to draw on their personal and family resources to solve issues and connect with others who might be able to assist. They also help the person to identify the things they have to offer so that support becomes mutual. This fits into the overall approach of the Care Act to reduce, prevent, and delay the need for intervention.

An example of how a local authority in England has implemented this approach can be seen in Local area co-ordination: supporting transformation in Derby.

Community strengths-mapping

Community strengths-mapping is an exercise which can help local authorities conceptualise and describe community strengths. The diagram below sets out how a local authority might think about the community resources that exist around the person. The person's own contacts in the community may include formal and informal networks (i.e. personal relationships in the form of clubs and/or memberships of organisations). The steps a local authority might take in mapping, negotiating and facilitating access to community strengths might follow this progression:

1. Meet the people in the person's support network (especially where the person has flagged that they have informal networks) to explore what resources (time, capacity, skills and knowledge) might be available to help the person.

2. Contact people who are active in the community (especially formal networks that are relevant in the person's daily life) and establish what scope there is in the organisation to adapt to the person's, or indeed the local, need. It may for instance be possible to organise collective transport for people who attend church services together. Where a local authority doesn't have local area coordinators, health visitors might be a means of identifying people who are engaged in their local area.

3. Recruit. Develop local clubs and organisations by supporting people who are active in the community to engage more people.

4. Use those networks to identify needs and resources. Identifying needs that are not being met is a positive outcome for local authorities that want to develop local organisations. Where there is a collective need, there is a possibility for an organised response.

5. Map the resources. Ensure that there is a contacts directory which is maintained and enables more people to get in touch easily.

6. Maintain contact with local activity leads. By building multi-agency partnerships, engagement can be sustained and the reach of the organisation expanded.

The diagram below illustrates how commissioners can consider community strengths and resources in terms of what exists around the person being assessed. The purple circles show where people come together outside the local authority's sphere of direct influence. People's activity has an impact on other spheres of public life (the white circles), which the council can influence through broader strategic public spending. Assessors can go so far in identifying existing resources, but if a broader strategy to develop local activities is employed, then more spheres can be 'opened up', allowing the strengths-based approach to meeting needs to become better resourced and more sustainable.

As the picture below illustrates, our communities are full of people with diverse skills, qualities and life experiences, but this may not always be recognised. Another element of adopting a strengths-based approach is to recognise skills within the community.
View a larger version of the above picture
Very often it is formal qualifications or professional expertise that are valued, when in fact it is attributes and qualities such as local knowledge, communication skills and a desire to contribute and participate that assist our communities and permit the individuals within them to thrive.

The strengths-based approach starts with the premise that all of us have something to offer, including people who need support to participate fully in the community, and even people nearing the end of their lives.

Having created an overview of the person's and the community's resources, the assessor and the commissioner can overlay the person's needs and skills with those in the community and, in this way, integrate the individual in the wider community. Skills for Care has developed a method for achieving this called 'Skills around the person'. [ 3] More information can be found on the Skills for Care website.

Implications for practice

The strengths-based approach will in many places result in a cultural shift, with the local authority focusing on the person's strengths and abilities. It means thinking positively about people who need care and support as well as engaging with the community to reduce isolation and draw those with care and support needs further into community networks. The strengths-based approach is about reducing dependency and challenging 'prescription culture'. Crucially, it is about protecting and promoting the person's independence, resilience, choice and wellbeing.

The Care Act requires local authorities to have a strengths-based approach throughout the user's journey and enshrined within all interventions/interactions with individuals. Here are some of the implications for practice.

Practitioners need to have greater knowledge and awareness of community resources and social capital, particularly within the area in which they work. Managers should allow time for practitioners to research and gain this knowledge.

Practitioners must prepare assessments thoroughly. Time for preparation of assessment should be taken into account for performance purposes and definition of workloads. Other changes in assessment methods (e.g. supported self-assessment, third-party assessment and improved prevention) should provide opportunities to regain time.

Assessment should be a collaborative process of gathering information through a conversation drawn from open questions with the individual.

Assessments should be outcome-based and not output-based - i.e. they are about what needs to change rather than what someone needs to do.

Senior management, middle management and practitioners will have to make adjustments and allowances to accommodate strengths-based practice. The key implications of this will be:

assessments (including preparation and closure) could take longer

accountability and decision-making are delegated to frontline staff, following a competency-based approach to ensure staff are confident and competent to work in this way

monitoring and review, and therefore performance measures, should focus on the impact of interventions in improving/changing outcomes for individuals

the need to establish where the process can be streamlined to free up time (e.g. identifying process bottlenecks such as mandatory sign-off or unproductive handovers; offering supported self-assessment and planning for those who do not need local authority intervention; making better use of partners as trusted assessors).

Checklist of core duties for local authorities

The checklist below provides a brief summary of the core duties in relation to conducting a strengths-based assessment. It should be read in conjunction with the Care and Support (Assessment) Regulations 2014 and Chapter 6 of the statutory guidance.
Local authorities must:

Provide or arrange for services, facilities or resources which will prevent, delay or reduce individuals' needs for care and support or the need for the support of carers.

Carry out an appropriate and proportionate assessment.

Carry out a capacity assessment if they believe an individual may lack capacity.

Support the individual to be involved in the assessment. This involves providing as much information as possible from the time of first contact, in an accessible format, so that the individual undertaking the supported self-assessment has a full and clear picture.

Involve an advocate (a family member, friend or independent advocate) to help the individual through the process if they have substantial difficulty understanding, retaining and using the relevant information.

Ensure the assessment is undertaken by a practitioner who is appropriately trained and has experience of the condition, or consults someone who has. If the user is deafblind the practitioner must have specialist training to carry out the assessment.

Carry out a safeguarding inquiry where a person may be at risk of abuse or neglect.

Consider what else (other than the provision of care and support) might assist the person in meeting the outcomes they want to achieve.

Ensure the care and support plan, or support plan, is, as far as possible, agreed by the adult or carer in question.

Video: What is a strengths-based approach?

View video with chapters, transcript and downloads

Useful resources

Think Local Act Personal: The Royal Society of Arts has published 'The new social care: strengths-based approaches', edited by TLAP co-chair and Shared Lives Plus CEO, Alex Fox.

Tools such as the ROPES (resources, opportunities, possibilities, exceptions, and solutions) model4 have been developed to guide practitioners in a broader process of continually drawing on strengths. Using frameworks focused on strengths and weaknesses encourages a holistic and balanced assessment of the strengths and problems of an individual within a specific situation.

Graybeal C (2001) 'Strengths-based social work assessment: transforming the dominant paradigm', Families in society: the journal of contemporary human services.

Berg, C.J. (2009) 'A comprehensive framework for conducting client assessments: highlighting strengths, environmental factors and hope', Journal of Practical Consulting, vol 3, no 2, pp 9-13

'Care bill paves way for strengths-based approach to care'

Community Catalysts, In Control, Inclusion North, Inclusive Neighbourhoods, Partners in Policymaking, Shared Lives Plus (2014) Strengths-based approach in the Care Bill.

Institute for Research and Innovation in Social Services (2012) Insight: Strength-based approaches for working with individuals.

Skills for Care (2014) Skills around the person: implementing asset-based approaches in adult social care and end of life care.

Improvement & Development Agency and the Local Government Association (2010) A glass half-full: how an asset approach can improve community health and wellbeing.

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

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Care Act guidance on Strengths-based approaches

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Published: March 2015 The Care Act 2014 requires local authorities to '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' in considering 'what else other than the provision of care and support might assist the person in meeting the outcomes they want to achieve'.

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Social Care Institute for Excellence (SCIE)

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Person-centred care moves away from professionals deciding what is best for a patient or service user, and places the person at the centre, as an expert of their own experience. The person, and their family where appropriate, becomes an equal partner in the planning of their care and support, ensuring it meets their needs, goals, and outcomes.

With an emphasis on doing with rather than doing to, person-centred care runs through both individual and group settings, allowing users of services to be active not only in their own care but also in the design and delivery of services. This approach can improve both the experience and quality of care.

Person-centred care relies on a number of aspects, including:

people's values and putting people at the centre of care

taking into account people's preferences and chosen needs

ensuring people are physically comfortable and safe

emotional support involving family and friends

making sure people have access to appropriate care that they need, when and where they need it

ensuring people get all the information they need, in a way that is accessible for them, to make decisions for their care and support.

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Person-centred care: Prevention practice examples and research - SCIE

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Person-centred care moves away from professionals deciding what is best for a patient or service user, and places the person at the centre, as an expert of their own experience. The person, and their family where appropriate, becomes an equal partner in the planning of their care and support, ensuring it meets their needs, goals, and outcomes.

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People from abroad, refugees, asylum seekers and immigrants.

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People from abroad, refugees, asylum seekers and immigrants.

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https://www.edp24.co.uk/news/politics/top-award-for-social-workers-who-help-norfolk-s-syrian-refugees-to-start-new-lives-1-5811236

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The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

It covers decisions about day-to-day things like what to wear or what to buy for the weekly shop, or serious life-changing decisions like whether to move into a care home or have major surgery.

Examples of people who may lack capacity include those with:

But just because a person has one of these health conditions does not necessarily mean they lack the capacity to make a specific decision.

Someone can lack capacity to make some decisions (for example, to decide on complex financial issues) but still have the capacity to make other decisions (for example, to decide what items to buy at the local shop).

The MCA says:

assume a person has the capacity to make a decision themselves, unless it's proved otherwise

wherever possible, help people to make their own decisions

do not treat a person as lacking the capacity to make a decision just because they make an unwise decision

if you make a decision for someone who does not have capacity, it must be in their best interests

treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

The MCA also allows people to express their preferences for care and treatment, and to appoint a trusted person to make a decision on their behalf should they lack capacity in the future.

People should also be provided with an independent advocate, who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests.

How is mental capacity assessed?

The MCA sets out a 2-stage test of capacity:

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time - someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

The MCA says a person is unable to make a decision if they cannot:

understand the information relevant to the decision

retain that information

use or weigh up that information as part of the process of making the decision

Helping people make their own decisions

Before deciding a person lacks capacity, it's important to take steps to enable them to try to make the decision themselves.

For example:

does the person have all the relevant information they need?

have they been given information on any alternatives?

could information be explained or presented in a way that's easier for them to understand (for example, by using simple language or visual aids)?

have different methods of communication been explored, such as non-verbal communication?

could anyone else help with communication, such as a family member, carer or advocate?

are there particular times of day when the person's understanding is better?

are there particular locations where the person may feel more at ease?

could the decision be delayed until they might be better able to make the decision?

Is the decision in their best interests?

If someone lacks the capacity to make a decision and the decision needs to be made for them, the MCA states the decision must be made in their best interests.

The MCA sets out a checklist to consider when deciding what's in a person's best interests.

It says you should:

encourage participation - do whatever's possible to permit or encourage the person to take part

identify all relevant circumstances - try to identify the things the individual lacking capacity would take into account if they were making the decision themselves

find out the person's views - including their past and present wishes and feelings, and any beliefs or values

avoid discrimination - do not make assumptions on the basis of age, appearance, condition or behaviour

assess whether the person might regain capacity - if they might, could the decision be postponed?

It's vital to consult with others for their views about the person's best interests.

In particular, try to consult:

anyone previously named by the individual

anyone engaged in caring for them

close relatives and friends

any attorney appointed under a Lasting Power of Attorney or Enduring Power of Attorney

any deputy appointed by the Court of Protection to make decisions for the person

Finding the least restrictive option

Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms.

This is called finding the "least restrictive alternative". It includes considering whether there's a need to act or make a decision at all.

Where there's more than one option, it's important to explore ways that would be less restrictive or allow the most freedom for a person who lacks capacity.

But the final decision must always allow the original purpose of the decision or act to be achieved.

Any decision or action must still be in the best interests of the person who lacks capacity.

So sometimes it may be necessary to choose an option that is not the least restrictive alternative if that option is in the person's best interests.

Deprivation of liberty

In certain cases, the restrictions placed upon a person who lacks capacity may amount to "deprivation of liberty". This must be judged on a case-by-case basis.

Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to apply to their local authority.

They'll then arrange an assessment of the person's care and treatment to decide if the deprivation of liberty is in the best interests of the individual concerned.

If it is, the local authority will grant a legal authorisation. If it is not, the care and treatment package must be changed - otherwise, an unlawful deprivation of liberty will occur. This system is known as the Deprivation of Liberty Safeguards.

If you suspect a deprivation of liberty may happen, talk to the care provider and then possibly the local authority.

Advance statements and decisions

An advance statement is a written statement that sets down a person's preferences, wishes, beliefs and values regarding their future care. It's not legally binding.

The aim is to provide a guide for anyone who might have to make decisions in a person's best interests if that person has lost the capacity to make decisions or communicate their decision.

An advance statement can cover any aspect of a person's future health or social care.

This could include:

how they want any religious or spiritual beliefs they hold to be reflected in their care

where they would like to be cared for - for example, at home or in a hospital, nursing home or hospice

how they like to do things - for example, if they prefer a shower instead of a bath, or like to sleep with the light on

concerns about practical issues - for example, who will look after their pet if they become ill

Find out more about making advance statements
An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a legally binding decision that allows someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may lack capacity to consent to or refuse that treatment.

An advance decision must be valid and applicable to current circumstances. If it is, it has the same effect as a decision made by a person with capacity - healthcare professionals must follow the decision.

If the advance decision refuses life-sustaining treatment, it must:

be in writing, signed and witnessed

state clearly that the decision applies even if life is at risk

People who make an advance decision may wish to consider letting their family, friends and carers know about it.
Find out more about advance decisions
Lasting Powers of Attorney

You can grant a Lasting Power of Attorney (LPA) to another person (or people) to enable them to make decisions about your health and welfare, or decisions about your property and financial affairs.

Separate legal documents are made for each of these decisions, appointing one or more attorneys for each.

An Enduring Power of Attorney (EPA) under the previous law was restricted to making decisions over property and affairs, which includes financial affairs and accessing the person's information.

An EPA made before the Mental Capacity Act came into force on 1 October 2007 remains valid.

Powers of attorney can be made at any time when the person making it has the mental capacity to do so, provided they're 18 or over.

Both an EPA and LPA must be registered. An LPA can be registered at any time, but a personal welfare LPA will only be effective once the person has lost the capacity to make their own decisions.

When acting under an LPA, an attorney (the appointed person) must:

make sure the MCA's statutory principles are followed

check whether the person has the capacity to make that particular decision for themselves - if they do, a personal welfare LPA cannot be used and the person must make the decision

In addition, the Court of Protection will be able to appoint deputies who can also take decisions on health and welfare and financial matters if the person concerned lacks the capacity to make a decision.

They'll come into action when the court needs to delegate an ongoing series of decisions rather than one decision.

If the person concerned already has an LPA appointed, they will not normally need a deputy as well.

The Office of the Public Guardian registers LPAs and EPAs, and supervises court-appointed deputies.

It provides evidence to the Court of Protection and information and guidance to the public.

The Public Guardian works with a range of agencies, such as the financial sector, police and social services, to investigate concerns.

The Court of Protection

The Court of Protection oversees the operation of the Mental Capacity Act and deals with all issues, including financial and serious healthcare matters, concerning people who lack the mental capacity to make their own decisions.

The court also tries to resolve all disputes when the person's carer, healthcare worker or social worker disagree about what's in the person's best interests, or when the views of the attorneys conflict in relation to property and welfare.

The court hears important cases, such as whether the NHS should withdraw treatment, whether a serious medical treatment decision is in a person's best interests, or whether it's in a person's best interests to be deprived of their liberty.

Cases can be brought to the court by family members, as well as advocates and professionals involved in decisions.

Professionals' duties under the Mental Capacity Act

The Mental Capacity Act applies to all professions - doctors, nurses, social workers, occupational therapists, healthcare assistants, and support staff.

These staff and their employers have a duty to ensure they know how to use it.

Most trusts and local authorities will have a Mental Capacity Act lead who provides specialist advice on how the Act works.

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Mental Capacity Act - Social care and support guide

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What is the Mental Capacity Act and what does it mean for you?

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It is ok to be conflicted!

It is not always black and white. Often people might understand one element of the decision to be made and not another.

You might find the 'decision to be made' wording difficult.

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This page explains what self-funding means and what to do if the money you use to pay for your care runs out.

While you're paying for your own care, you're free to choose the care services you want. Once we provide financial assistance, we'll work with you to decide how best to meet your needs.

What is self-funding?

A self-funder is someone who pays for the full cost of their social care and support. You're a self-funder if either:

You choose to find and pay for your care without involving us

You have been assessed by the council as needing care and support but have assets worth more than £23,250

Assets can include, but are not limited to, savings, property and investments such as shares, stocks or bonds.

Get financial advice for self-funding

It's a good idea to get independent financial advice on funding your care. We've provided a list of information, advice and advocacy organisations that can help you, or you could talk to an independent financial advisor.

If you decide to use an independent financial advisor, you should check they hold qualifications that demonstrate their understanding of care funding. The Money Advice Service has more information about financial advisors.

Advice may include:

Ensuring you're receiving all the benefits you are entitled to

Reducing the risk of running out of money (for example, budgeting effectively or avoiding scams)

Recommending ways to protect your money

Helping to protect your assets

Reviewing your assets, including your property and personal goods, to boost your income

The Norfolk Directory provides details of other organisations, including voluntary organisations who will also able to provide financial advice and support. Go to the Norfolk Community Directory.

Asking for financial help

If the value of your assets is likely to reduce to £23,250 as a result of paying for care, you may be eligible for support from us.

It will help us prepare if you can contact us when your savings fall below £30,000, as it takes time to put funding arrangements in place. Contact our social care team so we can assess your needs and finances.

The first thing we'll do is to arrange for an assessment of your care and support needs. If you qualify for help and no longer need to fund the entire cost of your care services, we have a duty to provide or arrange the services you need.

Following the care needs assessment, most people will have a financial assessment to work out how much they will need to pay towards the cost of their care when they are no longer a self-funder.

These assessments are carried out by telephone, online or face-to-face depending on your needs and financial circumstances. The assessment will consider your capital, benefits and pension incomes to work out how much you will need to pay towards the cost of your care.

You'll no longer need to pay the full cost of your care services when your assets drop below £23,250. The financial assessment will calculate the amount you will need to pay towards the cost of your care.

If you give money or assets away to avoid paying for your own care or to receive financial help sooner, we may ask the person who received the money or assets to pay for some (or all) of the cost of your care.

How much will the council pay towards your care?

After your care and support assessment, we'll let you know your personal budget. This is the total amount that we've agreed can meet your social care and support needs.

The amount that we'll pay may be less than the amount that you have been paying directly. We will, however, provide information about other providers within your personal budget.

If you wish to continue with your current provider there may be alternative arrangements available, including the two following examples.

Deferred Payment Agreements (DPA)

If your savings are under £23,250 but you own a property that is included within your financial assessment, you may be eligible for a DPA. This is where your care fees are secured against the equity in your property.

Any balance on a DPA will be reclaimed from the sale proceeds when your property is sold. You will need to make a part-payment towards the cost of your care in the meantime. Get more information about DPAs.

Top-ups (residential care only)

If you wish to remain with your chosen care provider, you may need to ask someone to pay the shortfall. This is called a Third Party Top-up. You cannot pay this from your savings.

Further information

For more information please contact the Financial Assessment Team on 01603 222133 (Option 2) or email fab@norfolk.gov.uk

You may also find the following websites useful:

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Get information if you have to pay for your own care: this includes a list of information, advice and advocacy organisations and help on getting independent financial advice. You can also ask Norfolk's Adult Social Services for a care and support assessment.

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Money Advice Service. Local Authority Funding.

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Money Advice Service. Local Authority Funding.

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If you need support with day-to-day tasks, or you need to move into a care home, your local authority might help with the costs of care. Exactly how much you get will depend on your care needs and how much you can afford to pay.
What care services do local authorities provide?

As well as providing places in care homes, local authorities can help you stay in your own home if you have care needs.

Services they provide include:

meals

carers

transport

home modifications

equipment that helps with the tasks of daily living.

Some services are provided free but your local authority will only pay for other services if your income and savings are low.

If you don't fully qualify for help, you'll either need to pay something towards your care costs, or meet the full cost yourself.

If you have a disability or complex medical condition that means you have healthcare needs rather than social care needs, you might qualify for NHS funding.

How to find out if you qualify for local authority funding for care costs

Contact the social services department of your local authority to find out whether you're eligible for funding.

If you have savings and assets of more than the amount in this table, you'll have to pay for your own care:

If your income and savings are above this limit it's still worth contacting the local authority.

As you still have the right to a care needs assessment, regardless of your financial situation.

Your local authority or trust might still take some of your income, if you're below these limits.

Getting a local authority care needs assessment

Before they can help, your local council must carry out a care needs assessment. It's free and it's your legal right to have one.

You should not be refused an assessment because the local authority thinks your needs aren't great enough or that you won't qualify for financial help.

The local authority will identify your care needs and check that they meet a nationally agreed set of criteria.

If you qualify for help, they have a legal duty to provide or arrange the services you need.

They will then carry out a financial assessment to work out if you should pay towards any services you need.

If you live in Northern Ireland

If you live in Northern Ireland, your local Health and Social Care Trust will carry out a social care needs assessment.

Self-assessment

You can also assess your own care needs or complete an assessment for someone else.

This could be done online and sets out in your own words the care that you think you, or a person you care for, might need.

If your local authority agrees with this self-assessment, you'll be able to access the same range of support services as if you'd been through a full care needs assessment from a local authority care specialist.

Financial assessment and eligibility

If you qualify for help, the local authority will carry out a financial assessment, called a 'means test'.

This helps to work out how much you should pay towards the cost of your care.

The outcome of the financial assessment

The outcome of the financial assessment will be that the local authority will either:

agree to meet the full cost of your care needs

agree to meet some of the cost (and you'll need to top up the rest)

leave you meet the full cost of your care.

If your local authority is supporting you they will then set up a personal budget for you which keeps track of the costs of your care

Deciding who manages your personal care budget

If you do qualify for financial help, you can:

ask your local authority to arrange the care services for you

receive direct payments from the council and organise things yourself. This can mean greater independence, choice and control of your care and your finances

ask someone else to manage your budget and organise services for you. This could be a family member, friend, care professional or an independent advocate.

What to do if you don't agree with the council's decision

You can challenge your local authority's decision if:

they refuse to pay for your care services

you don't think you've been offered enough support to meet your needs.

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Local authority funding for care costs - do you qualify?

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If you need support with day-to-day tasks, or you need to move into a care home, your local authority might help with the costs of care. Exactly how much you get will depend on your care needs and how much you can afford to pay.

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Advocacy Support Service for Adults in Norfolk

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Advocacy Support Service for Adults in Norfolk

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How to access independent advocacy support:

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It is important you are fully involved in your assessment and support planning. If you have difficulty in being involved we will consider how best to support you. This may involve providing information in a different format, ensuring a trained worker visits you in your home, or inviting a translator to help during your assessment.

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What financial support will I get from my local council?

After you've had the care needs assessment from your local council, they will do a financial means test.

For the means test, they will look at your income, savings and property to work out how much you need to contribute towards the cost of your care and support.

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How much you will need to contribute to your care costs will depend on a number of factors. Age UK provide the many options available to you. Read now.

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https://www.communitycare.co.uk/2017/07/10/care-acts-wellbeing-principle-mean-practice/

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Advice on services, training, counselling for carers

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Find local services, advice and support to help you, including the carer's assessment and carer's emergency card

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Support and advice for carers

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New Service Update

Please be advised that as of 1 st September 2020 the adult carers services contract will be delivered by Bridges Outcome Partnerships in partnership with Carers Matter Norfolk. Your main points of contact with the service - the advice line and carer connectors - will not change, however we are working to consolidate and improve our offerings to better support carers in Norfolk. As part of the improvements, we will be migrating our existing data into a new case management system. If you have any queries, do not hesitate to contact NCC at schpc@norfolk.gov.uk.

You can find out more about the new service here.

For all Coronavirus updates and information please click here.

Welcome to Carers Matter Norfolk Are you looking after a friend or family member who
due to illness, disability, mental health or addiction
cannot manage without your support?

If so, you are one of 100,000 unpaid carers living in
Norfolk. You might also be caring at a distance, looking
after someone living in Norfolk. Or you may be a
young carer, looking after a parent, brother or sister.

Carers Matter Norfolk is here to support you. Sign up for support here Info for Young Carers

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Please be advised that as of 1 st September 2020 the adult carers services contract will be delivered by Bridges Outcome Partnerships in partnership with Carers Matter Norfolk. Your main points of contact with the service - the advice line and carer connectors - will not change, however we are working to consolidate and improve our offerings to better support carers in Norfolk.

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https://communitydirectory.norfolk.gov.uk/Services/5752

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Norwich Escalation Avoidance Team (NEAT) 

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Norwich Escalation Avoidance Team (NEAT) 

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Supports with Crisis situations (unplanned health and social care needs) - professional referrals service

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Back to Search Results Printer Friendly Format

Norwich Escalation Avoidance Team (NEAT) provides Norwich's single point of access for urgent, unplanned health and social care needs where co-located staff work together to coordinate an integrated response which supports and manages patients and carers safely in the community through a period of crises, using the most appropriate level of intervention.

There is a cost associated with this service.

Target Groups:

Blind / Visual impairment, Carer, Deaf / Hearing impairment, Disability, End of Life / Palliative, Learning Disabilities, Mental Health, NHS and Social Service staff, Older people, Substance Misusers

Referral Procedure:

Referral is via a health / social professional only.

How Service is Delivered:

NEAT does not deliver services directly but through a multi-agency disciplinary meeting we coordinate a crises plan using existing resources to support patient to avoid unnecessary hospital or residential care. We are a telephone service only but the services we deploy have various methods of service delivery including home visits.

Opening Times:

Monday to Friday, 8 a.m - 6 p.m.
Saturday, 9 a.m - 5 p.m.
Sunday, 10 a.m - 4 p.m.
Referrals are accepted up to 30 minutes before closing time.

Compliments / Complaints:

To feedback about this services please contact Norwich Clinical Commissioning Group

Locations Served:

Bowthorpe, Lakenham, Mile Cross, New Costessey, Norwich, Old Catton, Sprowston, Taverham, Thorpe St Andrew

If you believe any of the details listed here to be out of date or in any way incorrect,
please use the Feedback page to advise the Webmaster.

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Back to Search Results Printer Friendly Format Norwich Escalation Avoidance Team (NEAT) provides Norwich's single point of access for urgent, unplanned health and social care needs where co-located staff work together to coordinate an integrated response which supports and manages patients and carers safely in the community through a period of crises, using the most appropriate level of intervention.

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NHS continuing healthcare is an ongoing package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a primary health need. Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness.

NHS-funded nursing care is registered nursing care funded by the NHS for eligible nursing home residents.

The NHS-funded nursing care rate for the 2019 to 2020 financial year is £165.56 per patient per week. The Department of Health and Social Care has agreed to review the 2019 to 2020 NHS-funded nursing care rate. The outcome of this review, and any impact on the 2019 to 2020 NHS-funded nursing care rate, will be announced later in 2019.

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NHS continuing healthcare and NHS-funded nursing care

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NHS continuing healthcare is an ongoing package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a primary health need. Such care is provided to an individual aged 18 or over to meet needs that have arisen as a result of disability, accident or illness.

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Eligibility outcomes for adults with care and support needs under the Care Act 2014

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Eligibility outcomes for adults with care and support needs under the Care Act 2014

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Social Care Institute for Excellence (SCIE)

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Adults with care and support needs

The eligibility decision-making process for adults with care and support needs involves the consideration of the following three criteria:

Managing and maintaining nutrition Open

What to consider

Does the adult have access to food and drink to maintain nutrition and are they able to prepare and consume the food and drink?

Examples of circumstances affecting the ability to achieve the outcome

If the adult is eating a restricted or unhealthy diet (e.g. only eats toast):

they may have difficulty in getting to the shops to buy food

they may be able to prepare food but have swallowing problems.

Maintaining personal hygiene Open

What to consider

Is the adult able to wash themselves and launder their clothes?

Examples of circumstances affecting the ability to achieve the outcome

If the adult cannot reach to wash themselves all over, this is not hygienic.

If the adult does not have access to a washing machine and their mobility is poor, clothes and linen may not be properly clean.

If the adult cannot buy cleaning products, or cognitively understand how to operate a washing machine, their clothes and linen may not be properly clean.

Managing toilet needs Open

What to consider

Is the adult able to access and use the toilet and manage their own toilet needs?

Examples of circumstances affecting the ability to achieve the outcome

If the toilet is no longer accessible due to mobility problems or if the adult takes too long to get to the toilet, they may not be managing their toilet needs.

If the adult is unable to maintain their night-time continence, they may not be managing their toilet needs in a way that promotes their dignity.

Being appropriately clothed Open

What to consider

Is the adult able to dress themselves and be appropriately dressed, for example, in relation to the weather or the activities they are undertaking, which could include work/volunteering?

Examples of circumstances affecting the ability to achieve the outcome

If the adult cannot put on or fasten their clothes, they are unlikely to be appropriately dressed.

If the adult cannot acquire new clothes when needed, they may not be appropriately dressed e.g. for the change in seasons.

The adult may be able to dress themselves in casual clothes unaided but may not be able to dress themselves in more formal work clothes e.g. put on a tie, zip up a dress or clean their shoes, and so would not be appropriately dressed for their circumstances.

If they are severely visually impaired, for example, they may be able to dress themselves but not know if clothes are appropriate or clean.

Note: This may also affect another outcome in relation to accessing work or volunteering.

Being able to make use of the adult's home safely Open

What to consider

Is the adult able to move around the home safely, including climbing steps, using kitchen facilities and accessing the bathroom/toilet?

This also includes their immediate environment e.g. steps to the home.

Examples of circumstances affecting the ability to achieve the outcome

If the adult cannot reach certain rooms, they may not be using the home safely or may be unreasonably confined e.g. having to spend all day in bed.

If the adult cannot get in or out of the front door (e.g. because they cannot manage the steps), they are unlikely to be using the home safely or have proper access to it.

If the adult is unable to use home appliances properly and safely (e.g. cooker, heater), they may not be meeting this outcome.

Maintaining a habitable home environment Open

What to consider

Is the adult's home sufficiently clean and maintained to be safe, including having essential amenities?

Does the adult require support to sustain the home or maintain amenities such as water, electricity and gas or pay their rent or mortgage?

Examples of circumstances affecting the ability to achieve the outcome

If the adult is unable to pay their rent or utility bills (e.g. due to mental or physical incapacity), they will not be able to sustain their home.

It may not be a habitable home environment if:

the home is damp or in very poor repair

the adult is unable to clean their kitchen, leading to infestation

the adult is hoarding excessively (note: hoarding per se does not determine eligibility; however, the impact of excessive hoarding on the individual's ability to achieve their outcomes, and thereby on their wellbeing, will affect eligibility).

Developing and maintaining family or other personal relationship Open

What to consider

Is the adult lonely or isolated?

Do their needs prevent them from maintaining or developing relationships with family and friends?

Examples of circumstances affecting the ability to achieve the outcome

The adult's physical or psychological state may prevent them from making or maintaining relationships e.g. mental ill-health, autism.

If the adult is unable to communicate easily and regularly - e.g. they may not have, or be able to use, a phone or computer, they may be unable to leave their home safely, they may be unable to communicate successfully or interact with others - this may prevent them from maintaining or developing relationships with family, friends and others.

Accessing and engaging in work, training, education or volunteering Open

What to consider

Does the adult have the opportunity and/or wish to apply themselves and contribute to society through work, training, education or volunteering?

This includes physical access to any facility and support with participation in the relevant activity.

Examples of circumstances affecting the ability to achieve the outcome

If the adult is unable to leave their home safely, or communicate successfully, or interact with others, they may not be able to access work, training, education or volunteering.

If the adult is unable to access information about opportunities available to them, they are unlikely to be able to engage in activities.

Making use of necessary facilities or services in the local community, including public transport, and recreational facilities or services Open

What to consider

Is the adult able to get around in the community safely and able to use facilities such as public transport, shops and recreational facilities?

This includes the need for support when attending health care appointments.

Examples of circumstances affecting the ability to achieve the outcome

If the adult is unable to walk, or to use public transport unattended or to organise alternative transport (e.g. someone giving them a lift), or does not have money for a taxi, they may not be able to access services locally.

As well as formal appointments e.g. health care appointments, this could include informal appointments e.g. being able to go to the library or to meet a friend in a cafe or pub.

Carers with support needs

The eligibility decision-making process for carers with support needs involves the consideration of the following three criteria:

Maintaining a habitable home environment in the carer's home, whether or not this is also the home of the adult needing care Open

What to consider

Is the carer's home a safe and appropriate environment to live in?

Does it present a significant risk to the carer's wellbeing?

A habitable home should be safe and have essential amenities such as water, electricity and gas.

Examples of circumstances affecting the ability to achieve the outcome

If the carer's role means that they are unable to pay their bills, or do not have time to deal with the maintenance of their home e.g. if there is a damp problem, they may not be maintaining a habitable home.

If the carer is caring for somebody in their own home, and there is not enough space in the home, it may not be a habitable environment.

If the carer and the adult with care and support needs share a home, and the adult's condition means that they have high expectations about the home maintenance that the carer 'struggles' to meet, the carer may be not meeting this outcome.

Managing and maintaining nutrition Open

What to consider

Does the carer have time to do essential shopping and to prepare meals for themselves and their family?

Examples of circumstances affecting the ability to achieve the outcome

If the carer lacks the time or opportunity to shop for or cook appropriate meals, they and their family may eat a restricted or unhealthy diet.

If the carer is not eating or avoiding eating certain foods to maintain a health condition, they may not be maintaining nutrition for themselves.

Developing and maintaining family or other personal relationships Open

What to consider

Does the carer's role prevent them from maintaining or developing relationships with family and friends?

Examples of circumstances affecting the ability to achieve the outcome

If the carer is unable to keep in touch with their family and friends, they may not be able to maintain or develop friendships and other relationships.

This could occur due to the attention and time commitment of their caring role, meaning that they are unavailable at times when family members or friends are free e.g. in the evenings and at weekends; or because they do not have a phone or computer and/or are tied to the house due to their caring role.

If the carer has no time or energy left after fulfilling their caring role, e.g. when looking after an adult child with care and support needs, they may not be able to maintain existing or develop other relationships.

Engaging in work, training, education or volunteering Open

What to consider

Is the carer able to continue in their job, contribute to society, apply themselves in education and volunteer to support civil society or have the opportunity to get a job, if they are not in employment?

Examples of circumstances affecting the ability to achieve the outcome

If the carer has no time or energy left after fulfilling their caring role, they may not be able to engage in work, training, education or volunteering.

If the carer has to take too many days off work or has to use all of their holiday entitlement to fulfil their caring role, they may not be able to find or maintain suitable employment or commit to a regular volunteering role.

Making use of necessary facilities or services in the local community, including recreational facilities or services Open

What to consider

Does the carer have opportunities to make use of local community services and facilities e.g. library, cinema, gym or swimming pool?

Examples of circumstances affecting the ability to achieve the outcome

If the carer has no time or energy left after fulfilling their caring role, they may not be able to make use of necessary facilities or services.

If an adult with care and support needs disapproves of their carer making use of the facilities or services in the local community, or prevents them from doing so, this may have an impact on the carer's desired outcomes/wellbeing.

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

Care Act 2014: Eligibility determination for the Care Act 2014

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Eligibility outcomes under the Care Act 2014

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The eligibility decision-making process for adults with care and support needs involves the consideration of the following three criteria: What to consider Does the adult have access to food and drink to maintain nutrition and are they able to prepare and consume the food and drink?

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The Mental Health Act predominantly used to detain individuals in a place of safety or psychiatric hospital who are posing a risk to themselves or others. The Act also covers admission via acute hospital or prison. Assessments under the Act can involve a Social Worker (if they are the Approved Mental Health Practitioner). In order to manage the assessment process there is an AMHP service based at Hellesdon hospital.

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Adult Social Care Residential Charging Policy

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Adult Social Care Residential Charging Policy

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Adult Social Care Non-Residential Charging Policy 

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Adult Social Care Non-Residential Charging Policy 

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NCC Non-Residential Charging Policy April 2020

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Assessment / Forms

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Housing with care is a mid point between living in your own home in the community and residential care. Generally for older adults but the demographic in some areas is changing to a mix of ages. The HWC complexes are managed by City / District Councils and have care on-site. Some have Dementia flats in a secure area. It's not quite like the care villages in Sweden but offers the  independence of your own flat with facilities and care. You will need an ASSD assessment in support and to request HWC on the housing register. Here's the intranet page for more guidance.
https://intranet.norfolk.gov.uk/search?uid=bc861889-0671-4860-9248-ee289116b2ed%7BD428623E-5727-4597-845D-58786DBB21F6%7D&searchFor=housing+with+care

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Your guide to charges for home care and other non-residential care services 14 April

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Deprivation of Liberty Safeguards (DoLs)  

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Deprivation of Liberty Safeguards (DoLs)  

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DoLs is used to place a individuals who lack Mental Capacity at a Care home  for their own protection. It is routinely referred for by the Care home if they feel a client may leave their facility as they are disorientated about where they are. It is particularly relevant in client with a dementia.

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Social Care Institute for Excellence (SCIE)

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Key messages

The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. They apply in England and Wales only.

The Mental Capacity Act allows some restraint and restrictions to be used - but only if they are in a person's best interests and necessary and proportionate.

Extra safeguards are needed if the restrictions and restraint used will deprive a person of their liberty. These are called the Deprivation of Liberty Safeguards.

The Deprivation of Liberty Safeguards can only be used if the person will be deprived of their liberty in a care home or hospital. In other settings the Court of Protection can authorise a deprivation of liberty.

Care homes or hospitals must ask a local authority if they can deprive a person of their liberty. This is called requesting a standard authorisation.

There are six assessments which have to take place before a standard authorisation can be given.

If a standard authorisation is given, one key safeguard is that the person has someone appointed with legal powers to represent them. This is called the relevant person's representative and will usually be a family member or friend.

Other safeguards include rights to challenge authorisations in the Court of Protection, and access to Independent Mental Capacity Advocates (IMCAs).

Liberty Protection Safeguards (LPS): In July 2018, the Government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). Under LPS, there will be a streamlined process for authorising deprivations of liberty. Until LPS is fully implemented the current process remains. Read more: Liberty Protection Safeguards.

What is a deprivation of liberty?

Article 5 of the Human Rights Act states that 'everyone has the right to liberty and security of person. No one shall be deprived of his or her liberty [unless] in accordance with a procedure prescribed in law'. The Deprivation of Liberty Safeguards (DoLS) is the procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm.

A Supreme Court judgement in March 2014 made reference to the 'acid test' to see whether a person is being deprived of their liberty, which consisted of two questions:

Is the person subject to continuous supervision and control? and

Is the person free to leave? (permanently) - with the focus, the Law Society advises us, being not on whether a person seems to be wanting to leave, but on how those who support them would react if they did want to leave.

If someone is subject to a high level of supervision, and is not free to leave the premises permanently, then it is almost certain that they are being deprived of their liberty. Each case must be considered on its own merits, but in addition to the two 'acid test' questions, if the following features are present, you must request the completion of assessments for a deprivation of liberty authorisation:

frequent use of sedation/medication to control behaviour

regular use of physical restraint to control behaviour

the person concerned objects verbally or physically to the restriction and/or restraint

objections from family and/or friends to the restriction or restraint

the person is confined to a particular part of the establishment in which they are being cared for

the placement is potentially unstable

possible challenge to the restriction and restraint being proposed to the Court of Protection or the Ombudsman, or a letter of complaint or a solicitor's letter

the person is already subject to a deprivation of liberty authorisation which is about to expire.

Restraint and restrictions

The Mental Capacity Act allows restrictions and restraint in some cases to be used in a person's support, but only if they are in the best interests of a person who lacks capacity to make the decision themselves and only if it is necessary and proportionate to do so. The urgency of the situation would be part of the consideration of whether to apply a short term restraint or restriction, to provide care or treatment, for example.

Final decisions about what amounts to a deprivation of liberty are made by courts. The Code of Practice for the Deprivation of Liberty Safeguards (DoLS) gives examples of where courts have found people being and not being deprived of their liberty. These examples, together with other cases which have gone to the courts, should be used as a guide.

When care providers are putting together the care plans for people who are unable to make decisions about their care or where they live, they should consider whether any restrictions or restraint being proposed, in the best interests of the person, amount to a deprivation of liberty.

Practice example

Ben has learning disabilities and Prader-Willi syndrome. There are concerns about his health because his weight has been increasing steadily and now stands at 120kg.

Staff in his residential home have tried to support Ben to limit what he eats and to make healthy choices but with little effect.

Ben has been assessed as lacking capacity to make decisions about the amount and type of food he eats (this is common among people with Prader-Willi syndrome). It has been proposed that it is in Ben's best interests to stop him going into the kitchen, and always supervising him when out, to prevent him spending all his money on, or stealing, food. An application is made by the home manager for standard authorisation because they believe that the restrictions would deprive Ben of his liberty.

How is deprivation of liberty authorised under DoLS?

The Deprivation of Liberty Safeguards (DoLS) can only apply to people who are in a care home or hospital. This includes where there are plans to move a person to a care home or hospital where they may be deprived of their liberty. The care home or hospital is called the managing authority in the DoLS. Where a managing authority thinks it needs to deprive someone of their liberty they have to ask for this to be authorised by a supervisory body. They can do this up to 28 days in advance of when they plan to deprive the person of their liberty.

For care homes and hospitals the supervisory body is the local authority where the person is ordinarily resident. Usually this will be the local authority where the care home is located unless the person is funded by a different local authority.

The managing authority must fill out a form requesting a standard authorisation. This is sent to the supervisory body which has to decide within 21 days whether the person can be deprived of their liberty.

The supervisory body appoints assessors to see if the conditions are met to allow the person to be deprived of their liberty under the safeguards. They include:

The person is 18 or over (different safeguards currently apply for children).

The person is suffering from a mental disorder (recognised by the Mental Health Act).

The person lacks capacity to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment.

The restrictions would deprive the person of their liberty.

The proposed restrictions would be in the person's best interests.

Whether the person should instead be considered for detention under the Mental Health Act.

There is no valid advance decision to refuse treatment or support that would be overridden by any DoLS process.

Whether a person who holds Lasting Power of Attorney (LPA) for Health and Welfare agrees with a DoLS authorisation (no refusals).

If any of the conditions are not met, deprivation of liberty cannot be authorised. This may mean that the care home or hospital has to change its care plan so that the person can be supported in a less restrictive way. There may be also be a need to consider asking the Court of Protection to look at the Deprivation of Liberty, supervisory bodies must seek legal advice in these cases.

If all conditions are met, the supervisory body must authorise the deprivation of liberty and inform the person and managing authority in writing. It can be authorised for up to one year.

The person does not have to be deprived of their liberty for the duration of the authorisation. The restrictions should stop as soon as they are no longer required.

Conditions on the standard authorisation can be set by the supervisory body. These must be followed by the managing authority.

Standard authorisations cannot be extended. If it is felt that a person still needs to be deprived of their liberty at the end of an authorisation, the managing authority must request another standard authorisation (or renewal).

Practice example

Claire has an acquired brain injury. Her GP has referred her to the local hospital for a minor operation on her foot. The doctor assessed Claire as lacking capacity to make the treatment decision herself and so after consulting Claire's mother is proposing that it is in her best interests to have the surgery. From past experience it is known that Claire will need to be sedated throughout her stay in hospital.

This is to stop her removing the dressing and picking at the wound. On the advice of the GP, the hospital makes an application for a standard authorisation for the use of sedation which is granted before she is admitted.

Urgent authorisations

A person may need to be deprived of their liberty before the supervisory body can respond to a request for a standard authorisation. In these situations the managing authority can use an urgent authorisation. Urgent authorisations are granted by the managing authority itself. There is a form that they have to complete and send to the supervisory body.

The managing authority can deprive a person of their liberty for up to seven days using an urgent authorisation. It can only be extended (for up to a further seven days) if the supervisory body agrees to a request made by the managing authority to do this.

When using an urgent authorisation the managing authority must also make a request for a standard authorisation. The managing authority must have a reasonable belief that a standard authorisation would be granted if using an urgent authorisation.

Before granting an urgent authorisation, the managing authority should try to speak to the family, friends and carers of the person. Their knowledge of the person could mean that deprivation of liberty can be avoided. The managing authority should make a record of their efforts to consult others.

Practice example

Brian has been living in a nursing home for the past three years. Recently he has become very agitated and distressed which is thought to be linked to his dementia. He tells people he wants to go home not remembering that he had to give his flat up when he moved into the home. He also spends a lot of time trying to open the front door which has a key pad lock on. An incident has occurred where he climbed out of his ground floor bedroom window and was only found a couple of hours later on a main road. The nursing home asks the local authority for a standard authorisation. They want to continue to use the key code so that Brian does not go out unaccompanied, and to put safety locks on some of the windows. Because of the seriousness of the recent incident, the home manager completes the form for the urgent authorisation and arranges the window locks to be fitted the same day.

Safeguards for people who may be deprived of their liberty

The first safeguard is the assessment process for a standard authorisation which involves at least two independent assessors who must have received training for their role. There will always be one mental health assessor and one best interests assessor who will stop deprivation of liberty being authorised if they do not think all the conditions are met.

Family, friends and paid carers who know the person well should be consulted as part of the assessment process. They may have suggestions about how the person can be supported without having to deprive them of their liberty. Those people who don't have family or friends who can represent them have a right to the support of an Independent Mental Capacity Advocate (IMCA) during the assessment process. And at all times, the fifth principle of the Mental Capacity Act, that any decision made in a person's best interests must be the least restrictive of their rights and freedoms, should be borne in mind.

If the person has an unpaid relevant person's representative following an authorisation, both they and their representative are entitled to the support of an Independent Mental Capacity Advocate.

If standard authorisation is granted the following safeguards are available:

The person must be appointed a relevant person's representative as soon as possible. Usually this will be a family member or friend who agrees to take this role. If there is no one willing or able to take this role on an unpaid basis, the supervisory body must pay someone, such as an advocate, to do this.

The person and their representative can require the authorisation to be reviewed at any time, to see whether the criteria to deprive the person of their liberty are still met, and if so whether any conditions need to change.

The person and their relevant person's representative have a right to challenge the deprivation of liberty in the Court of Protection at any time.

If the person has an unpaid relevant person's representative, both they and their representative are entitled to the support of an IMCA. It is good practice for supervisory bodies to arrange for an IMCA to explain their role directly to both when a new authorisation has been granted.

The home or hospital should do all it reasonably can to explain to a detained person and their family what their rights of appeal are and give support.

When DoLS cannot be used

The Deprivation of Liberty Safeguards (DoLS) can only be used if a person is in hospital or a care home. If a person is living in another setting, including in supported living or their own home, it is still possible to deprive the person of their liberty in their best interests, via an application to the Court of Protection.

If a person is in hospital they should not be subject to the DoLS if they meet the criteria for detention under the Mental Health Act.

The DoLS should not be used if the main reason is to restrict contact with individuals who may cause the person harm. If it is believed to be in a person's best interests to limit contact an application should be made to the Court of Protection.

DoLS should also not be used if the sole purpose of the restrictions are to protect other people, the safeguards are for the individual.

If there is a dispute about where a person should stay, an authorisation does not resolve the dispute. The Code of Practice of the Mental Capacity Act says that unresolved disputes about residence, including the person themselves disagreeing, should be referred to the Court of Protection.

Practice example

The local authority is following safeguarding proceedings for Mavis, a woman with dementia who is currently living at home with her husband. They are concerned her needs are not being met because her husband is refusing the support that is being offered. It is believed that he has untreated mental health needs. Mavis was assessed as lacking capacity to decide on her residence, though clearly communicates a wish to remain in her own home.

It has been proposed that a placement in a care home would be in Mavis's best interests. It is also believed that in the care home she will need a high level of restrictions to give her appropriate care and treatment.

Because the move is against Mavis's wishes and those of her husband, the local authority makes a fast-track application to the Court of Protection to make a decision in her best interests. If the court authorises a move to the care home, an application will be made by the home for a standard authorisation under the DoLS.

Deprivation of liberty without authorisation

If you are working in a care home or hospital where you think a person is being deprived of their liberty, you should see if care could be provided in a less restrictive way. If depriving the person of their liberty seems unavoidable, an application should be made for a standard authorisation at the same time as an urgent authorisation is given.

If you come across someone in another setting who may be deprived of their liberty you should bring this to the attention of the manager so they either change their care or seek authorisation. Other options are to inform the supervisory body, to make a safeguarding alert to the local authority, or to challenge what may be an unlawful deprivation of liberty in the Court of Protection.

Other information

If a care/nursing home or hospital makes an application to a local authority for a deprivation of liberty authorisation, it must inform the Care Quality Commission, once the outcome of the application is known. CQC provides a form for this purpose. Similarly, if a supported living, shared lives or other community provider requests an authorisation of a deprivation of liberty from the Court of Protection, the CQC must be informed once the outcome is known, using the same form. (Download CQC statutory notification: Application to deprive a person of their liberty and its outcome)

Liberty Protection Safeguards

In July 2018, the government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). This passed into law in May 2019. Under LPS, there will be a streamlined process to authorise deprivations of liberty. Read more here: Liberty Protection Safeguards.

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

Deprivation of Liberty Safeguards (DoLS) at a glance

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Deprivation of Liberty Safeguards at a glance

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Information about the Deprivation of Liberty Safeguards (DOLS) - an amendment to the Mental Capacity Act 2005 (MCA).

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Your guide to residential and nursing home care charges

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Used to be Business Support. They do a lot of the same things as Development Workers and there is a crossover. Different teams use them differently. They might do things like make follow up calls.

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When working with Adults you regularly support people under s117 of the Mental Health Act 1983. Social Services have a responsibility to provide support/services to meet needs. These needs are reviewed yearly. The persons Health needs are also assessed by the Community Mental Health Team. The CMHT have a repsonsibility to meet these needs.

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The 3 Conversation Model

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We recognise that people and families are the experts in their own lives, so as social and health care workers we need to listen hard to them and use the resources and skills we have to build on their wishes and strengths, and to connect them to the right people, communities and organisations to make their lives work better.

We believe our current social and health care system functions like a sorting office, where we attach labels to people and send them off down predetermined routes to 'one-size fits all' services. We need to stop making assumptions and passing people around like parcels for someone else to deal with somewhere else in the system and start working with them until we're sure they're safe and that their plan for a good life is working.

We know our response in a crisis is critical. Many of the people and families we meet need urgent help to get their lives back on track - so rather than assessing them for services, we must stick with them, and not even think about eligibility or longer-term support until the immediate crisis is over.

We know that language is really important too, so we don't use words that de-humanise (no more 'service users' or 'cases'), and we stop talking about pathways and journeys, allocation and referrals, screening and triage, because that's the language of a system we're no longer prepared to tolerate.

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The Three Conversations® - Partners4Change home

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We recognise that people and families are the experts in their own lives, so as social and health care workers we need to listen hard to them and use the resources and skills we have to build on their wishes and strengths, and to connect them to the right people, communities and organisations to make their lives work better.

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Most people have to make a contribution towards the cost of their care.

You may get some financial help from us, but how much you will receive depends on what you have in savings and capital.

Find out information on the changes to charges, relating to the MIG and PIP, taking place during the coronavirus outbreak.

If you want to work out what help you might get, you can use our online financial calculator.

You won't need to include the value of your home if you are looking to have care at home.

If you have more than £23,250 in savings and capital

You won't be eligible for any financial help towards the costs of your care and support.

There are organisations that can help you to plan and make choices about your care in this instance and you should always seek independent financial advice.

See our page If you pay for your own care for further information.

If you have less than £23,250 in savings and capital

You'll get some financial help from us towards the cost of your care and support.

We will look at your income. You'll need to have a financial assessment so that we can work out how much we'll pay and how much you'll pay.

The assessment will focus on solely on your finances. If you have a partner or spouse their circumstances will not be considered, although you should tell us about any savings or capital held in joint names. Find out what you will need to bring to your financial assessment.

We will also look at any Disability Related Expenses you have when making our assessment. We will take these off the amount we consider to be your available income, reducing the amount you pay. Find out about how we work out your expenses and download the form.

We'll then work with you to develop a care and support plan. This will set out how your needs will be met.

If you want more information about care at home and how we may be able to help you, contact our social care team.

Care charges

You may find the following leaflets useful with regards to care charges and paying for care.
Your guide to charges for home care and other non-residential care services Your guide to residential and nursing home charges Your guide to moving to a NORSE-run housing with care scheme

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Most people have to make a contribution towards the cost of their care. You may get some financial help from us, but how much you will receive depends on what you have in savings and capital. Find out information on the changes to charges, relating to the MIG and PIP, taking place during the coronavirus outbreak.

# data[].attributes.attachment_link.readable_text
Most people have to make a contribution towards the cost of their care.

You may get some financial help from us, but how much you will receive depends on what you have in savings and capital.

Find out information on the changes to charges, relating to the MIG and PIP, taking place during the coronavirus outbreak.

If you want to work out what help you might get, you can use our online financial calculator.

You won't need to include the value of your home if you are looking to have care at home.

If you have more than £23,250 in savings and capital

You won't be eligible for any financial help towards the costs of your care and support.

There are organisations that can help you to plan and make choices about your care in this instance and you should always seek independent financial advice.

See our page If you pay for your own care for further information.

If you have less than £23,250 in savings and capital

You'll get some financial help from us towards the cost of your care and support.

We will look at your income. You'll need to have a financial assessment so that we can work out how much we'll pay and how much you'll pay.

The assessment will focus on solely on your finances. If you have a partner or spouse their circumstances will not be considered, although you should tell us about any savings or capital held in joint names. Find out what you will need to bring to your financial assessment.

We will also look at any Disability Related Expenses you have when making our assessment. We will take these off the amount we consider to be your available income, reducing the amount you pay. Find out about how we work out your expenses and download the form.

We'll then work with you to develop a care and support plan. This will set out how your needs will be met.

If you want more information about care at home and how we may be able to help you, contact our social care team.

Care charges

You may find the following leaflets useful with regards to care charges and paying for care.
Your guide to charges for home care and other non-residential care services Your guide to residential and nursing home charges Your guide to moving to a NORSE-run housing with care scheme

# data[].attributes.attachment_link.description
Most people have to make a contribution towards the cost of their care. You may get some financial help from us, but how much you will receive depends on what you have in savings and capital. Find out information on the changes to charges, relating to the MIG and PIP, taking place during the coronavirus outbreak.

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Eligibility for NHS funding: checklist.

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Screening tool to help identify individuals who may need a referral for a full assessment of eligibility for NHS continuing healthcare.

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Screening tool to help identify individuals who may need a referral for a full assessment of eligibility for NHS continuing healthcare.

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Links:

The second box on the page is a great learning support document - ADASS Learning Support Document for Self-neglect and Hoarding 2020  -https://intranet.norfolk.gov.uk/search?searchFor=Self-neglect (ASSD)&page=2

Policies & Procedures and Risk Assessment Tool - https://intranet.norfolk.gov.uk/departments/adult-social-services/social-care-practice/policies-procedures-and-best-practice/safeguarding/self-neglect-121

Clutter Scale -  this rating can act as a measure of clutter. In general, clutter that reaches the level of picture no.4 or higher impinges enough on people’s lives that we would encourage them to get help for their hoarding problem. https://hoardingdisordersuk.org/wp-content/uploads/2014/01/clutter-image-ratings.pdf

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Link to the community directory / Care and Support directory

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Link to the community directory / Care and Support directory

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https://communitydirectory.norfolk.gov.uk/

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Assessment and Eligibility - process map 

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Assessment and Eligibility - process map 

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This flowchart shows the processes involved in assessment and eligibility. Please click on the boxes to reveal more detailed description of each stage of the process.

Introduction

This step covers the need for a local authority to ensure that individuals who may lack capacity to ask for, or engage with, a needs assessment are fully supported and that the process is person-centred and compliant with the Mental Capacity Act.

Core duties

The local authority must:

assume a person has capacity unless it is established that they lack capacity. A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success

ensure that the person's wellbeing is considered including that their wishes and feelings are identified and listened to.

give the person, from their very first contact with the local authority, as much information as possible about the assessment process and about the many different ways of being engaged

seek to establish the total extent of the person's needs and how they impact on their wellbeing, and the outcomes they want to achieve through the assessment, before considering the person's eligibility for care and support.

Process description

From the start of the process the local authority must give the person as much information as possible about the steps involved in assessment - and about the different ways they can engage that might be relevant for the person.

The local authority must ensure the individual has the mental capacity to fully understand and be involved with the assessment by checking that they:

The local authority must conduct a capacity assessment at any point during the assessment process if they have reason to think the individual involved may lack capacity.

Link to Act

Link to Guidance

Links to other Resources

Next step

Consideration of the person's capacity is an ongoing responsibility throughout the process, to which the local authority must pay attention.

Introduction

This step covers what the authority must consider to ensure that a person can be fully involved in the needs and carer's assessment and when appropriate, facilitate that person's involvement.

In this context 'advocacy' means supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need. The requirement to provide independent advocacy applies equally to individuals requiring care or support and to carers with support needs.

Core duties

The local authority must:

ensure that the person is able to be involved as far as possible/support the person to be involved

where appropriate, consider reasonable adjustments under the Equality Act 2010

consider whether the person would have 'substantial difficulty' in being involved in the assessment

provide access to independent advocacy for those who have substantial difficulty and have no appropriate individual who can support their involvement

seek to establish the total extent of needs through the assessment before considering the person's eligibility for care or support.

Process description

The local authority must be confident at all times that the person involved in the assessment is fully supported - either the person requiring support or care and/or their carer - to be at the centre of the process. From the point of first contact the local authority will need to consider whether the person requiring care or support or their carers have 'substantial difficulty' in being involved in the assessment. This consideration should be based on four areas:

Where an individual has substantial difficulty in any of the above areas they require assistance.

If it is thought that the individual does have substantial difficultly, and if there is no appropriate individual who can support and represent them to facilitate their involvement, then the local authority must arrange for an independent advocate to support and represent the person.

Examples of an appropriate person may include:

If the local authority determines there is no one available or capable of representing the individual who is judged to have 'substantial difficulty' it must appoint an independent advocate to provide this support and representation. It must also consider any needs for independent advocacy that the person's carer may have and ensure these needs are met.

In determining an appropriate individual to support and represent the person and to facilitate their involvement in the assessment process, the local authority should consider that it is not sufficient to know the person well or even to love them deeply. The appropriate individual must be able to support the person's active involvement with the local authority processes. Some examples when people may not easily be able to fulfil this role include:

A person will never be considered appropriate where they are implicated in any enquiry of abuse or neglect, or have been judged by a safeguarding adults review (SAR) to have failed to prevent abuse or neglect.

The role of the independent advocate is to support and represent the person and to facilitate their involvement in the key processes and interactions with the local authority and other organisations as required. The advocate must support and represent the person:

Section 7 of the Care and Support Statutory Guidance provides detailed advice on this issue.

Link to Act

Link to Guidance

Links to other Resources

Link to SCIE resources

Next step

This is an ongoing requirement in the assessment process, through care and support planning and review processes and therefore must be continuously monitored.

Introduction

This step considers the requirement for the local authority to take a holistic view of the impact on the whole family and any potential need for a carer's assessment.

Core duties

The local authority must:

Process description

The local authority must at all times throughout the assessment process take into account the impact of the adult's needs on the whole family and on those with caring responsibilities. This includes identification of any adults or children who are providing care.

This means the local authority must identify who the family and support network are.

The local authority must also identify any other adults in need of care and support during the process. For example:

If the assessor finds that an adult has a carer, who in turn has parenting responsibilities and caring responsibilities for an elderly relative in addition to the adult with care needs. This situation would constitute an 'appearance of need' and the assessor should then offer both a carer's assessment and an assessment for the elderly relative in addition to the assessment of the adult with care and support needs.

The local authority must consider the impact on the wellbeing of carers and others in the adult's support network and how they can help:

Where the local authority identifies carers or others in the adult's support network who are affected by their caring role, it must consider whether the provision of information and advice will be beneficial to them. The authority should also consider a carer's assessment.

If it is viewed as being of benefit to the individual, the local authority must advise the person on how to access appropriate advice and information. This may include actions such as signposting to support services where they are available in the local community.

Where the local authority identifies a child or children as being involved in the provision of care it must:

consider the impact of the needs of the individual concerned on the child's wellbeing, welfare, education and development and

identify whether any of the tasks which the child is performing for the individual are inappropriate for the child to perform, having regard to all circumstances.

If the person is eligible, care and support should be provided in a way that is sufficient to alleviate any (young) carer's inappropriate caring responsibilities. In practical terms this means:

The local authority must consider the need to refer the child or young person for a young carer's assessment under the Children Act 1989. This will also require ensuring adult and children's care and support services work together to ensure the process is smooth.

The local authority must consider the extent to which the caring responsibilities affect the young person's physical or emotional wellbeing. Caring might for instance prevent the child from 'normal' activity, such as building friendship networks or having other social contact, or prevent them from undertaking regular exercise if they wish to.

The local authority must consider the impact on the young person's wellbeing, education and development. An impact could for instance manifest itself in regular absence from school or college or other impacts such as an inability to concentrate in class.

The local authority must also consider whether the caring responsibilities of the young person are inappropriate having regard to all circumstances. Examples of inappropriate care tasks may include:

strenuous physical exercise, lifting and handling

personal care (for instance, bathing and managing toilet needs)

routinely handling cash transactions and looking after the family budget

providing emotional support.

This is not an exhaustive list and when making any assessment of caring responsibilities the local authority should take the young person's views on their own capabilities into account.

The local authority must also take into account the parenting responsibilities of the adult requiring care or support, alongside the impact their needs may have on the young carer.

Link to Act

Link to Guidance

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Introduction

This step considers the duty of the local authority to act upon any identified safeguarding issues as they occur. Where necessary the safeguarding process should run parallel to the assessment process and is not subject to any eligibility considerations.

The local authority should recognise that it should make a similar response where it considers that a carer is at risk of harm or abuse.

Core duties

The local authority must:

Process description

The safeguarding duties apply to an adult who:

If at any point the local authority suspects or receives information from another person or agency that an adult is experiencing, or is at risk of, abuse or neglect, it must make enquiries, or cause others to do so.

An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place. An enquiry may be a conversation with the adult, or, if the adult lacks capacity or has substantial difficulty in understanding the enquiry, a conversation with their representative or advocate, prior to initiating a formal enquiry under Section 42, right through to a much more formal multi-agency plan or course of action. The objectives of an enquiry into abuse or neglect are to:

If the local authority decides that another organisation should make the enquiry, for example a care provider, then it should be clear about timescales, the need to know the outcome of the enquiry and what action will follow if the enquiry is not completed.

The nature and timing of the intervention and who is best placed to lead it will be, in part, determined by the circumstances. However, the primary focus must still be what immediate steps need to be taken to protect the adult and whether there is a wider risk to other adults. It may need to be referred to the police to consider whether a criminal investigation is required or appropriate.

Local authorities must cooperate with each of their relevant partners, as described in Section 6(7) of the Care Act, and those partners must cooperate with the local authority in the exercise of their functions relevant to care and support, including those to protect adults. Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk through timely information-sharing and targeted multi-agency intervention.

Once enquiries are completed, the outcome should be notified to the local authority which should then determine with the adult what, if any, further action is necessary and acceptable. One outcome of the enquiry may be the formulation of agreed actions for the adult which should be recorded on their care plan. This will be the responsibility of the relevant agencies to implement. In relation to the adult this should set out:

Conducting a safeguarding enquiry, and any action which needs to be taken as a result, is entirely independent of the person's eligibility. It is of paramount importance that establishing the impact of the concerns is dealt with in parallel with the assessment process. This ensures the local authority can address safeguarding concerns effectively without disrupting the assessment process and meet its duty to meet eligible needs.

The adult who has care and support needs must be involved in addressing the safeguarding concerns or have a family member, friend or advocate able to support them.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Introduction

This step considers the individual person's strengths and capability as well as any support which may be available from their wider network and in their community. When looking at this potential support, local authorities should consider whether such networks have the capacity to continue to meet the adult's needs on a regular basis.

This helps to ensure the assessment is person-centred and focuses on both their individual and wider network's strengths rather than on their condition.

Core duties

The local authority must:

Process description

In conducting an appropriate and proportionate assessment the local authority should at all times ensure that the process takes into account not only the individual's needs for care and support but also the strengths they themselves have which could be mobilised to help the adult achieve their outcomes. A strengths-based approach values the capacity, skills and knowledge of an individual and their immediate family/carer network, as well as the existing connections to the person's community. It is important to note that this is not about imposing more on carers.

The local authority must, throughout the process, consider the person's own strengths and capabilities and work together to identify what support in the community may be accessed independently.

This will ensure that the needs and desired outcomes the person wishes to achieve are at the heart of the process along with consideration of the extent to which the person can provide solutions to their situation and assist the local authority in ensuring their care and support needs are met.

In some cases, a person's eligible needs may be met through support from their own networks or the wider community, and the local authority retains responsibility for ensuring that eligible needs are met and should review the situation should the person's circumstances change.

In order to achieve the benefits of the strengths-based approach, a full picture of the person's current and past situation will need to be built up. This will focus both on the problems the person is experiencing (a deficit-based approach) and on their history (e.g. their likes and dislikes, hobbies, occupation, social network etc.) to get a picture of their skills and abilities (a strengths-based approach). In the subsequent discussion it is possible that the assessor and the person may together identify potential sources of support not previously considered.

It also makes long-term strategic sense to invest in such support for adults with care and support needs and their carers in terms of confidence-building, independence, 'up-skilling' etc. for the individual and the overall contribution this makes to their wellbeing.

Link to Act

Link to Guidance

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Introduction

This step details the requirements on the local authority to ensure that the form of assessment is appropriate to support the individual's involvement. This means it will be as extensive as is required to establish the extent of a person's needs, will always be person-centred and will be based on their individual circumstances.

'Proportionate' and 'appropriate' are concepts that must be applied to all assessments and are not in themselves a form of care assessment.

Core duties

The local authority must:

seek to establish the total extent of needs through the assessment before considering the person's eligibility for care and support

consider whether the individual's needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn't identified, and must establish the impact of this on the adult's desired outcomes

carry out an assessment in a manner which is appropriate and proportionate to the needs and circumstances of the individual to whom it relates and ensure it has regard to the:

wishes and preferences of the individual to whom it relates

outcome the individual seeks from the assessment

severity and overall extent of the individual's needs.

Process description

The assessment process must have the needs of the person at its centre. That means the process must be suitable to the individual's capacity and capabilities, and any difficulties they may face in communication. The process must be proportionate to the extent and severity of the person's needs, which will have been identified at the stage of initial information gathering and subsequent contact.

Needs and carer's assessments must be carried out appropriately and proportionately - this may be applied in a range of ways. To ensure the method of assessment is appropriate local authorities must take into account the ability and situation of the individual being assessed; establish how much they want to be involved in the assessment and meet that wish as far as is possible. Formats of assessment include but are not limited to:

face-to-face assessment between the person and an assessor;

supported self-assessment, where the person leads on the completion of the assessment material and the local authority assures itself that it is an accurate reflection of the person's needs;

online or phone assessment;

Joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments;

Combined assessment, where an adult's assessment is combined with a carer's assessment and/or an assessment relating to a child. It is, of course, important to recognise that where there is a young carer, their assessment will be conducted by children's services by an appropriately qualified assessor.

If both the adult with support needs and the carer have substantial difficulty in being involved in the assessment process, and do not have an appropriate individual to support them, an independent advocate must be arranged.

The local authority may be carrying out assessments of two people in the same household. If both people agree to have the same advocate, and if the local authority consider there is no conflict of interest between the individuals or either of the individuals and the advocate, then the same advocate may support and represent the two people.

For the assessment to be proportionate this will involve:

To address proportionality the assessor will be required to take into account that needs may differ in their breadth and depth, meaning it may be necessary to:

These considerations will ensure the extent of the assessment is proportionate, is not overly burdensome and recognises both the individual's and their carer's own knowledge and capacity.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

Information-gathering and signposting.

Introduction

This step provides an overview of the responsibilities of the local authority from first contact with a person who appears to have a need for care and support. The first contact sees the local authority providing as much information as possible on the assessment process and where possible taking action to prevent or delay the need for care and support.

First contact is important, particularly as it may be the only contact some people will have with their local authority.

Core duties

The local authority must:

seek to establish the total extent of needs through the assessment before considering the person's eligibility for care and support;

ensure that staff are appropriately trained to carry out an assessment, be able to identify a person who may lack capacity and be able to steer people seeking support to appropriate information and advice

undertake proportionate and appropriate assessments of any adult or carer with an appearance of need, irrespective of any presumptions of the eligibility of the person's needs or financial situation

give the person, from their first contact with the local authority, as much information as possible about the assessment process, in a format that is accessible to the person.

Process description

This applies equally to adults with care and support needs and their carers.

Information gathered at first contact at this stage might usefully establish the basic facts about:

The local authority could also consider whether the person has an immediate network of support and how this network contributes to the individual achieving their desired outcomes.

It is important for the local authority to consider that many of the people who qualify for independent advocacy under the Care Act may also qualify for a mental capacity advocate (MCA). The same advocate can therefore provide support as an advocate under the Care Act and the Mental Capacity Act. This ensures that the person receives seamless advocacy support and also avoids them having to repeat their stories for support under different legislation to different advocates.

Link to Act

Link to Guidance

Next step
Urgent need?
Introduction

This step provides a narrative on the identification of an urgent need faced by an adult in need of care and support. This recognises the local authority can act on such a need without the need for assessment or eligibility checks.

Core duties

The local authority must:

consider whether the individual's needs impact upon their wellbeing and establish the impact of this on the adult's desired outcomes.

Process description

The Care Act 2014 provides the local authority with the power to meet urgent need without undertaking an assessment or making a determination of eligibility, regardless of the person's ordinary residence.

There will be instances where it is obvious that immediate action is required, and in such cases it is likely that the assessment will be paused to be resumed later so a fuller assessment can be conducted.

Circumstances under which needs could be classified as urgent include, for example"

This applies equally to adults with care and support needs and to carers with support needs.

Link to Act

Link to Guidance

Next step

Introduction

This step provides a narrative on action following the identification of an urgent need faced by an adult in their care and support. This recognises that the local authority can act on such a need without the need for assessment or eligibility determination.

Core duties

The local authority must:

Consider whether the individual's needs impact upon their wellbeing and must establish the impact of this on the adult's desired outcomes.

Process description

Having established that the individual faces an urgent need, the local authority can and should choose to provide support without first conducting an assessment or eligibility determination.

Under these circumstances the local authority should meet the identified urgent care needs immediately. It should also inform the individual that a more detailed needs assessment, an eligibility determination, establishment of ordinary residence and a financial assessment will follow the intervention.

This applies equally to adults with care and support needs and to carers with support needs.

Link to Act

Link to Guidance

Next step

Signposting and prevention.

Introduction

Following the provision of initial information to the individual on the assessment process, this step provides an overview of the requirements for the local authority to conduct initial information-gathering and assessing the appearance of needs. This builds on the provision of initial information provided at first contact (initial information-gathering and signposting) and may run concurrently, particularly in cases where there is no urgent need identified.

This also provides a narrative on the importance of the provision of information and advice to all who seek support from the local authority, irrespective of any existing care or determination of eligibility.

At this stage it may be possible to identify an early or targeted intervention, such as universal services, a period of reablement or provision of equipment or minor household adaptations which could prevent, reduce or delay the progression or development of an individual's needs . In these circumstances the assessment process will be paused so that any benefit to the adult from the intervention may be determined. If such an opportunity to try a preventative service is not identified the assessment will continue without pause.

Core duties

The local authority must:

seek to establish the total extent of needs through the assessment before considering the individual's eligibility for care and support

consider whether the individual's needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn't identified, and establish the impact of this on the adult's desired outcomes

consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the individual wants to achieve

ensure that the individual is able to be involved as far as possible, for example by providing an interpreter where they have a particular condition affecting communication - such as autism or deafblindness

offer an assessment where an individual previously refused an assessment and the local authority establishes that the adult's or carer's needs or circumstances have changed, unless the person continues to refuse

ensure the assessor is appropriately trained and has the right skills, knowledge and competence to carry out the assessment in question, whichever method is used

ensure that support is available to the assessor where the assessment relates to a specific condition or circumstances requiring expert insight (e.g. autism, learning disabilities, mental health needs or dementia).

This is a two stage process involving:

offer information and advice/refer to preventative services

proceed to the next step or pause the assessment process.

Process description

The objective is to ensure the individual receives a personalised approach to assessment. Staff must be appropriately trained to be able to carry out an assessment, and should have access to professional support to assist in the identification of more complex needs or underlying conditions.

If the initial information gathered suggests that the person would benefit from a targeted intervention or preventative service, the assessment may be paused while these are put in place and any benefits from them are realised. When the assessment is resumed it will focus on the remaining needs that have not been met by such interventions. If the local authority pauses the assessment, it should inform the person that they are doing so.

When the local authority provides information, it must be in an accessible format to support the individual's involvement in the process. A further and important part of this and every subsequent stage of the assessment process is the prevention, delay or reduction in the escalation of care and support needs. This will involve the local authority providing or arranging services that either:

help keep people well and independent

aim to reduce needs and help people regain skills.

It is important to note that prevention may be considered at different levels and may be utilised at any appropriate point in the assessment process:

The local authority's responsibilities for prevention apply to all adults, including:

This is an important step in ensuring the assessment is centred on the needs of the person and is appropriate and proportionate to the individual's circumstances. Establishing the correct initial information as well as enabling people to access preventative services will also save time and costs later.

Relevant protection is built into the process to ensure adults do not exit the assessment process too early, and suitable preventative interventions are put in place.

If the local authority decides not to proceed with assessment, alternatives to be considered are:

Pause: the local authority should consider if pausing the assessment process will be helpful in order to put in place and establish the benefit of any identified interventions, and the extent to which these prevent, reduce or delay the development of the adult's needs. Making use of the opportunity to pause the assessment enables the appropriate point to be reached at which the assessment can be continued appropriately.

Prevention: if a full needs or carer's assessment is not taken forward the local authority must ensure appropriate steps are taken to prevent, delay or reduce the escalation of care and support needs. Whatever level of prevention is implemented it is important that this is reviewed and the person returns to the assessment process if and when appropriate.

Signposting: the local authority must not let the person exit the assessment process without offering information and advice on coping with their condition or referring them to preventative services or to organisations in the community who can provide relevant support. The local authority must provide the person with information and advice on how to reduce or meet their needs and how to prevent, reduce or delay the development of needs.

Link to Act

Link to Guidance

Next step
Individual with care and support needs or carer with support needs?
Introduction

Often the immediate focus might be on the adult who requires care and support, however, the needs of any carer the individual has may require a separate assessment.

This step describes the process of identifying the person's needs and in particular whether it is just the individual who has care needs or if there are additional support needs for their carer caused by their responsibilities.

This requires the local authority to consider how these impact on the individual's wellbeing and to explore who else might be affected by the person's situation.

Core duties

The local authority must:

seek to establish the total extent of needs through the assessment before considering the person's eligibility for care and support

consider whether the individual's needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn't identified and establish the impact of this on the adult's desired outcomes;

Process description

The assessment must seek to establish a complete picture of the individual's needs, what outcomes they want to achieve in their day-to-day life and what impact this has on their wellbeing. In the case of a needs assessment of an adult with care and support needs, the assessment must discount the care currently provided by any carer to ensure that a full picture of the overall needs is established. It is important to understand what impact the provision of care may have on any carer's wellbeing.

If the information provided indicates that the carer might have needs for support due to their caring responsibilities, then the local authority must offer to undertake a carer's assessment for that individual.

Refusal of assessment

There is no absolute requirement for an individual - either a person with care needs or a carer with support needs - to have a needs or carers assessment. If an individual refuses an assessment, the local authority is not required to undertake one. People may choose not to have an assessment if they do not feel they need care or do not want local authority support.

Local authorities must assess a person who previously refused an assessment but has changed their mind.

Link to Act

Link to Guidance

Next step

Introduction

This step provides a narrative of the duty of the local authority to provide an assessment for any carer who appears to have any level of need for support.

Core duties

The local authority must:

offer an assessment to any carer with an appearance of need for support

ensure the carer is involved in their assessment along with anyone else they might want involved

seek to establish the total extent of needs through the assessment before considering the person's eligibility for support

establish whether the carer is willing and able to continue to provide care

establish whether the carer has substantial difficulty in being involved in the assessment process and, if there is no appropriate person to support them, appoint an independent advocate.

Process description

The local authority must ensure that any carer who may have support needs is offered a carer's assessment. This must happen irrespective of any future determination of eligibility and is important in establishing the fullest picture of the carer's needs and, importantly, the sustainability of the current arrangements.

The carer's assessment must seek to establish:

It must also consider:

The outcome of the carer's assessment will provide an understanding of the sustainability of the carer's input in the short, medium and long term. The general principles of assessment still govern a carer's assessment. For instance, the format of assessment must be appropriate to the carer's circumstances.

Refusal of assessment

There is no absolute requirement for an individual - either a person with care needs or a carer with support needs - to have a needs or carers assessment. If an individual refuses an assessment, the local authority is not required to undertake one. People may choose not to have an assessment if they do not feel they need care or do not want local authority support.

Local authorities must assess a person who previously refused an assessment but has changed their mind.

Link to Guidance

Links to other Resources

Carers' implementation support that Department of Health (DH) has commissioned from the ADASS carers network. Whole family guidance being ADASS Carers Network.

Next step

Needs and carers assessment.

Introduction

This step provides a narrative on the various approaches to conducting a needs or carer's assessment.

It also considers the requirement for the local authority to ensure that any assessment is appropriate and proportionate to the needs and circumstances of the individual and remains so for the duration of the assessment process.

Core duties

The local authority must:

Process description

Having determined the type of assessment, the local authority must identify the person's needs and how these impact on their wellbeing, and the outcomes that the person wishes to achieve in their day-to-day life.

The principle of proportionality means that an assessment goes as far as is necessary to establish a complete picture of the person's needs. The principle of appropriateness means that an assessment must be carried out in a manner that has regard to the person's wishes, preferences and outcomes, the complexity of the person's needs and any potential fluctuations of those needs.

Additional support may need to be provided (e.g. understanding may be aided through the provision of accessible information or independent advocacy).
Assessments can be undertaken via telephone or online, provided that the local authority has made sure it has fulfilled its duties in relation to the assessment and the need for safeguarding, independent advocacy and assessing mental capacity.

The local authority must ensure the assessment is person-centred, which may include provision of support in circumstances where there are capacity issues or specific difficulties in communication.

What constitutes an appropriate and proportionate assessment needs to be kept under constant review throughout the assessment and eligibility process to ensure the process fits the person's overall needs.

The SCIE Care Act hub provides practice examples of good practice in ensuring assessment is proportionate and appropriate, and can be found at: SCIE Care Act 2014.

In considering the specific assessment to be applied, the following checklist is a guide to choose which format to use:

Where can the assessment take place?

Who will conduct the assessment?

Are there any specific communication needs to be addressed?

When will the assessment take place?

What is the mental capacity of the adult with care needs?

Who has been consulted?

Who will be involved?

During assessment it is important to ensure the process remains person-centred, the impact of preventative services is considered in maintaining or improving the individual's wellbeing and the outcomes that the person sets for themselves are considered at all times.

It is also important to establish the needs of any carers in the process as an ongoing part of the assessment of an individual's needs and the impact these have on those around them.

Depending on the answers to these questions, any of the following forms of assessment may be deemed appropriate. They do not constitute an exhaustive list.

Link to Guidance

Links to other Resources

Whole family approach guidance being developed by Carers UK

Link to SCIE resources

Next step

Needs, outcomes and impact on wellbeing.

A face-to-face assessment is conducted between the person requiring care and support and an assessor, whose qualification and job title may vary depending on the circumstances, and who must always be appropriately trained, with the right skills and knowledge to conduct the relevant assessment. There may be other circumstances in which the local authority should ensure that the assessor has access to relevant expert knowledge.

Next step

Needs, outcomes and impact on wellbeing.

A supported self-assessment is where the same assessment materials are used as in a face-to-face assessment, but the person requiring care and support completes the assessment on their own and leads the assessment process, with appropriate help from a carer or advocate. The local authority must assure itself that the assessment is an accurate reflection of the person's needs (e.g. by consulting with other relevant professionals and people who know the person).

Next step

Needs, outcomes and impact on wellbeing.

A joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments (including assessments in a prison, where local authorities may need to put particular emphasis on cross-agency cooperation and sharing of expertise) is a good way to fit around the needs of an individual. Doing joint assessments with more than one agency or local authority requires good practice in sharing information and working together to ensure needs are accounted for and provided for in a coordinated way.

Transition assessments require joint working between adult and children's services to ensure changes in circumstances and desired outcomes are captured. Transition assessments of young people with care and support needs and young carers alike should therefore be conducted as a joint assessment.

Next step

Needs, outcomes and impact on wellbeing.

Online or phone assessment

An online or telephone assessment may be an appropriate way of carrying out an assessment if, for example, the person who needs care and support has less complex needs, or is already known to the local authority and it is carrying out an assessment following a change in the person's needs or circumstances.

Next step

Needs, outcomes and impact on wellbeing.

A combined assessment is when an adult's assessment is combined with a carer's assessment and/or an assessment relating to a child so that interrelated needs are properly captured and the process is as efficient as possible. If either of the individuals to be assessed disagrees with the proposal to combine assessments, the assessments must be carried out separately.

Next step

Needs, outcomes and impact on wellbeing.

Introduction

The step provides a summary of the individual's care needs, their desired personal outcomes and the impact of their condition and circumstances on their wellbeing.

Core duties

The local authority must:

Process description

The assessment must provide sufficient information for the assessor to be able to establish what the person's needs are and how they impact on the person's wellbeing, what outcomes they are seeking to achieve in their day-to-day life, and how care and support, or in the case of a carer, support, can contribute to the achievement of those outcomes. In order to make an eligibility determination, the assessor ought also to establish how the person's desired outcomes fit with the specified outcomes in the eligibility criteria.

Following the assessment the individual must be given a written record of their needs or carer's assessment. If the person asks the local authority to share the record with anyone, the local authority must do so. If an independent advocate has been involved in the process, the local authority should also inform them of the outcome of the assessment in order for the advocate to help the person understand the implications of the assessment.

As a minimum this must record:

the adult's care needs - including any supporting information from any combined or joint assessment

the carer's support needs - including any support information from any combined or joint assessment

the individual's outcomes - which in this context refer to the outcomes set by the person for themselves and not those associated with the eligibility determination

the impact on the individual's wellbeing of their care needs

any care being provided by a carer (this should still be recorded for the care planning process, if the person has eligible needs.

The SCIE Care Act hub provides practice examples of good practice in to How to assess for needs and outcomes and how these link to wellbeing which can be found at: SCIE Care Act 2014

Link to Act

Link to Guidance

Link to SCIE resources

Next step

Consider if needs are likely to fluctuate.

Introduction

This step considers the action required by the local authority to identify those needs of an adult with care and support needs which may not be apparent at the time of the assessment but which have been an issue in the past and which are likely to arise again in the future.

Core duties

The local authority must:

Process description

The local authority must consider the needs of an individual over an appropriate period of time to understand the full implications of their condition.

The point at which the local authority assesses the individual's needs may not be a true reflection of their condition over time. Where a condition is likely to present fluctuating need - which may mean that the individual is coping with a condition in which they have good and bad days, or parts of a day, or are well for weeks or months at a time - the local authority must assess the impact of this in order to reach the right eligibility decision and build a care and support plan that is suitable to the person's real needs.

The local authority should also consider that needs may not fluctuate because of a condition but may fluctuate because of changing circumstances such as changes in employment or education, or the transition to adult services, which may be the case for young carers entering adulthood. Carers' needs might fluctuate, for example because of school holidays or changes in employment.

This requires the local authority to consider the person's care and support history over a period of time which captures the fluctuating need the person or their representative reports, in terms of frequency and degree of fluctuation. It is vital to ensure that the impact of these varying needs on any carer is also considered as part of a carer's assessment.

If the individual's needs are likely to fluctuate, the local authority must make an accurate record of fluctuating needs to ensure they are effectively factored into the person's care plan, assuming their needs are eligible for support.

This could be done - for example - by the provision of flexible services resulting in a more responsive care plan that can save time if/when the person with care and support needs comes back into the system.

The local authority must also consider the impact the fluctuation in the adult's needs may have on their carers.

The SCIE Care Act hub provides practice examples of good practice associated with fluctuating need.

Link to Act

Link to Guidance

Link to SCIE resources

Next step
National minimum threshold for eligibility met?
Introduction

This section considers the local authority's duty to establish eligibility in relation to the minimum threshold set out in regulations for adults and carers. The use of the word 'eligible' here refers only to the needs of adults with care needs and carers with support needs, not to their financial resources or other circumstances

Core duties

The local authority must:

Process description

The minimum threshold for eligibility has been set to ensure that all local authorities meet the same minimum level of needs. This does not mean that local authorities cannot choose to meet needs that fall below this threshold, but that they must provide for needs that meet the following three conditions:

The needs arise from or are related to a physical or mental impairment or illness.

As a result of those needs the adult is unable to achieve two or more of the specified outcomes:

managing and maintaining nutrition

maintaining personal hygiene

managing toilet needs

being appropriately clothed

being able to make use of the home safely

maintaining a habitable home environment

developing and maintaining family or other personal relationships

accessing and engaging in work, training, education or volunteering

making use of necessary facilities or services in the local community, including public transport and recreational facilities or services

carrying out any caring responsibilities the adult has for a child

As a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult's wellbeing.

For an adult's needs to be considered eligible for support by the local authority they must meet all three criteria.

An adult is to be regarded as being unable to achieve an outcome if they:

Similarly, a carer's needs are eligible where they meet three conditions:

The needs arise as a consequence of providing necessary care for an adult

The effect of the needs is that any of the circumstances specified in the Care and Support (Eligibility) Regulations 2014 apply to the carer, namely:

the carer's physical or mental health is, or is at risk of, deteriorating

the carer is unable to achieve any of the following outcomes:

carrying out any caring responsibilities the carer has for a child

providing care to other persons for whom the carer provides care

maintaining a habitable home environment in the carer's home, whether or not this is also the home of the adult needing care

managing and maintaining nutrition

developing and maintaining family or other personal relationships

engaging in work, training, education or volunteering

making use of necessary facilities or services in the local community, including recreational facilities or services

engaging in recreational activities.

As a consequence of that fact there is, or there is likely to be, a significant impact on the carer's wellbeing.

For a carer's needs to be considered eligible for support by the local authority they must meet all three criteria.

A carer is to be regarded as being unable to achieve an outcome if they:

The Care Act guidance provides examples of how these outcomes could be interpreted or be relevant in a given situation of these eligibility criteria.

Following the outcome of the eligibility determination the local authority must provide the person to whom the determination refers with a copy of the decision. If the needs have been deemed not eligible, the local authority has to explain how they have reached this decision.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

If needs are eligible or if needs are ineligible.

Introduction

This step details the requirements on the local authority to provide information to adults who are determined as ineligible for support and care as well as providing preventative services.

Core duties

The local authority must:

establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers

ensure appropriate steps are taken to prevent, delay or reduce the escalation of care and support needs.

Process description

If, following completion of the assessment, the local authority deems that a person's needs are not eligible, it must provide information and advice on:

Meeting or reducing the needs e.g.:

the choice of types of care and support, and the choice of providers available in the community for the adult or their carer

how to access the care and support that is available

planning for future care and support needs

how to access independent financial advice on matters relevant to the meeting of needs for care and support.

Any package of information provided to the adult or carer should be tailored to reflect the needs of the individual, to prevent future needs and delay deterioration. This will ensure people are helped to access local services, which may be provided by the local authority or by another organisation.

The local authority must also take action to prevent or delay the development of needs, considered at different levels:

Link to Act

Link to Guidance

Link to SCIE resources

Next step

The process of assessment ends for people with needs that have been deemed ineligible.

The local authority should maintain a record of the person's need to be able to provide support in the future if their circumstances change.

Introduction

This step provides a narrative of the key points related to care and support planning relevant to the assessment and eligibility process.

Core duties

Things the local authority must do:

Process description

Following a determination that the adult in need of care and support, or the carer with support needs, is eligible for support, the local authority undertakes a detailed care and planning support process. This process is separate to the assessment and eligibility determination, and the local authority will need to satisfy the following before proceeding to plan to meet the agreed needs:

The local authority should discuss with the adult how their eligible needs will be met.

Establish the adult is ordinarily resident in the local authority's area.

Conduct a financial assessment.

Proceed to care and support planning, considering:

information and advice

what needs may already be met by a carer

what preventative services may be relevant.

Please note this step outlines only the local authority's core duties for care planning. For more detail on the process please refer to Delivering care and support planning from Think Local Act Personal.

Link to SCIE resources

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

Assessment and eligibility process map

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This flowchart shows the processes involved in assessment and eligibility. Please click on the boxes to reveal more detailed description of each stage of the process. This step covers the need for a local authority to ensure that individuals who may lack capacity to ask for, or engage with, a needs assessment are fully supported and that the process is person-centred and compliant with the Mental Capacity Act.

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DW's with people who are either assessed as not eligible for social services or where it appears that there may be a community solution that would mean a package of support might not be necessary or could be reduced.
They do this through connecting people with economical, local, activities relating to the individuals wishes and aspirations.
Link:

Development Workers https://intranet.norfolk.gov.uk/departments/adult-social-services/social-care-practice/policies-procedures-and-best-practice/prevention/development-workers--adult-social-services-116

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https://carersmatternorfolk.org.uk/

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Care Act 2014 - Assessment and Eligibility 

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Care Act 2014 - Assessment and Eligibility 

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The Care Act 2014 sets out in one place, local authorities' duties in relation to assessing people's needs and their eligibility for publicly funded care and support.

Under the Care Act 2014, local authorities must:

carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care

focus the assessment on the person's needs and how they impact on their wellbeing, and the outcomes they want to achieve

involve the person in the assessment and, where appropriate, their carer or someone else they nominate

provide access to an independent advocate to support the person's involvement in the assessment if required

consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

use the new national minimum threshold to judge eligibility for publicly funded care and support.

Assessment and eligibility resources

SCIE has developed a range of resources to support local authority staff, social workers and others involved in assessment and eligibility.

Implementation support

Related information
Fair access to care services (FACS): prioritising eligibility for care and support
Care and support reform programme
Care Act 2014: statutory guidance for implementation
Keep up to date

Make sure you know when we publish our new resources on the Care Act. Register for the SCIELine ebulletin.

To register for the Care and Support Reform bulletin, email CareBillReform@local.gov.uk

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The Care Act: Assessment and eligibility

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Care Act 2014 - Assessing people's needs and eligibility for funded care and support. Information on what local authorities must do under the Care Act. Assessment and eligibility resources including a process map, self assessment examples and guide, eligibility examples and videos. SCIE can help with Care Act implementation and support.

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https://www.gov.uk/government/collections/mental-capacity-act-making-decisions

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Link to Development Workers Page on intranet

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Link to Development Workers Page on intranet

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https://intranet.norfolk.gov.uk/departments/adult-social-services/early-help-and-prevention/development-workers

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Safeguarding

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An Act to make provision to reform the law relating to care and support for adults and the law relating to support for carers; to make provision about safeguarding adults from abuse or neglect; to make provision about care standards; to establish and make provision about Health Education England; to establish and make provision about the Health Research Authority; to make provision about integrating care and support with health services; and for connected purposes.

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Making a referral to Adult Social Services

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The hospital discharge process- Discharge to Assess.

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The hospital discharge process- Discharge to Assess.

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-The ‘Discharge to Assess’ conversation will be conducted in hospital and will be completed by health and social care professionals.
-This will determine whether a patient’s care needs require ongoing Social or NHS funded community care provision on discharge.
-If an NHS Continuing Healthcare (NHS CHC) consideration is identified initially to be required it should be conducted after discharge once optimum recovery is reached.  ‘Discharge to Assess’ NHS health funding where professionally judged necessary will be available for a 28 day period whilst the full assessment process for NHS Continuing Healthcare is completed.

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Resources - Day centres, Residential Care, Housing with Care, Development Workers, Living Well Officers.

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Resources - Day centres, Residential Care, Housing with Care, Development Workers, Living Well Officers.

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These can be used for new service users or when needs change. NFS can provide a free two week assessment period, at home. This will help to identify what support is needed and how often. After the assessment period, NFS will recommend ongoing support needs, which can then be sourced via local providers. NFS can continue to support after the free two week period, although this will then be charged.
Elizabeth (Liz )Beal is a great person to get in touch with any queries, very helpful! Look her up in NCC phonebook.
Links:

Referral Information Guidance - https://intranet.norfolk.gov.uk/departments/adult-social-services/social-care-practice/policies-procedures-and-best-practice/prevention/nfs-referral-information-guidance120#files-and-downloads

Referrals To NFS - https://intranet.norfolk.gov.uk/departments/adult-social-services/social-care-practice/policies-procedures-and-best-practice/prevention/referrals-to-norfolk-first-support-117

Norfolk First Support Charging - https://intranet.norfolk.gov.uk/departments/adult-social-services/social-care-practice/policies-procedures-and-best-practice/prevention/nfs-charging-059

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Development Workers - Have got a Teams page! 

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Development Workers - Have got a Teams page! 

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DWs are helpful folk who can act as your community resource 'knowledgebase.' You can make a referral on LAS. When you start in Adults contact Rosemary Henderson who will set up up on the Teams page. It has a files section so you might be able to find the resource you want there or make a referral if you don't have time to go looking.