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If you are interested in becoming a member of SNAP PCF then please complete a membership form
http://www.surveymonkey.co.uk/r/MembershipformtojoinSNAP
(Please note we will not share your personal details with any organisation without your permission)

If you are interested in a more active role and would like to join our parent panel which includes for example attending a workshop to give your views on subjects such as the Local Offer, universal services, Preparing for Adulthood etc. You will also be provided with lunch and a voucher for your time. We also need parents to attend events/running a stall and coffee mornings then please fill out the membership form for parent panel. We will be able to provide further information on this once we have received your membership form

We also have a membership for professionals who would like to receive our newsletters and information about our events here is the link SNAP PCF Professional Membership Form

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Become a Member of SNAP PCF - SNAP PCF - Central Bedfordshire

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Become a Member If you are interested in becoming a member of SNAP PCF then please complete a membership form http://www.surveymonkey.co.uk/r/MembershipformtojoinSNAP (Please note we will not share your personal details with any organisation without your permission) If you are interested

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There are essentially two types of care and support available to adults who need help to be able to manage their everyday lives.

1) Residential care

Residential care provides a person with both a place to live and the care and support that they need all in one place by the same organisation. These are generally called 'care homes', and are not just for the elderly. There are also care homes that are designed to support younger adults who need care and support, usually where a small group of disabled adults share their home together. Each adult usually has their own bedroom, together with the use of other communal spaces that are shared with the other people living in the care home. When looking for a care home for a young adult it is important to consider who they will be living with, to ensure that they will fit in well with the people already living there.

Care homes cover the cost of all of the adult's basic living needs including rent, utilities and food. Some also provide a schedule of onsite or offsite activities for those living at the home. The local authority and/or NHS will pay the organisation that operates the care home one single payment that covers both the accommodation and care costs for the young adult. As a result, some benefits that the young person may have been receiving before living at the care home will stop once they move in. This includes the care component of Disability Living Allowance (DLA) and the daily living component of Personal Independence Payment (PIP). However, the mobility element of these benefits will still continue to be paid to the adult while they are living at the care home.

Adults living in residential care homes should still be given as much choice and control over their lives as possible, and be encouraged to make as many decisions for themselves as they can e.g. what they eat, what to wear, what activities they participate in. Care home staff should support them to increase their independence and self-help skills by involving them in daily living tasks such as washing, cooking or laundry to the extent that they are able. They should continue to be supported to access education or work where they are able to do so.

2) Non-residential care

Non-residential care is support that is provided separately from the adult's housing arrangements. Support workers will travel to the person's home to support them where they are living. This might be to the family home if the young adult is still living with their parents or families, or to their own home if they are living independently in a property that they rent or own. Adults who receive non-residential care will continue to receive all of their benefits such as Universal Credit or Employment and Support Allowance, Disability Living Allowance or Personal Independence Payment. They will use these benefits to pay for their own rent, utilities and food, and can be supported to manage their finances by family members or their support workers. Adults living independently and who are unable to work or are on a low income, can have help with their rent costs by applying for Universal Credit or Housing Benefit.

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This guide is designed to help parents and carers of young people with disabilities, as they support their child to navigate their way towards and into adulthood. It includes information about education, healthcare, social care support, benefits and finances and options for moving out of home and living independently. For those parents wishing to understand a young person's legal rights to support and services, it also includes links to the relevant laws and statutory guidance.

The information has been presented by age and year group, to enable parents and carers to focus in on the information that may be most relevant to the age of their young person. Click on the images to take you to further information, explainer videos and other content. We would encourage you, where possible, to read and consider all of the information in this guide so that you can understand and begin the process of securing the support that your young person will need in adulthood well in advance of their 18th birthday.

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What happens when my child turns 18 and becomes an adult?

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What happens when my child turns 18 and becomes an adult?

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Before a child reaches 18, their parents or carers have legal rights and responsibilities, which is called having 'parental responsibility'. Parental responsibility means that parents and carers are primarily responsible for looking after their child, providing a home for them and protecting them from harm. Parents can also make most decisions for their child and independently decide what is best for them. The state can assist parents who have a disabled child by providing them extra support (such as offering respite care) but parents still remain primarily responsible for providing most of the care for their own children.

When a child reaches the age of 18 this changes. The child then legally becomes an adult and parental responsibility no longer applies. This means that parents are no longer legally required to meet the needs of their child, and the responsibility for providing any eligible support that their child still needs as an adult to keep themselves safe and to stay healthy transfers to the state. Local authorities are not allowed to assume that parent carers will continue to care for their child after they reach the age of 18. As family carers are no longer expected to care for their son or daughter when they become an adult, they only need to continue to provide the care for them that they are both willing and able to offer. This might mean continuing to provide all of their child's care if they choose, or providing some of their care with the rest being provided by the local authority and/or the NHS.

Reaching the age of 18 and becoming an adult also means that the young person can legally begin making decisions for themselves, unless they are deemed not to have mental capacity to make some or all of their own choices.

This guide will help explain these changes, what happens for adults who can not make all of their own decisions, and how parents or carers can secure the support that their young person may need in adulthood to be able to live the life that they chose. This may include living independently from their family carers if they wish to do so, or if their family carers are unable or unwilling to continue caring for them at home.

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What is Social Care and who provides it?

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What is Social Care and who provides it?

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Social Care means any care and support that is provided to someone who needs help with daily living tasks such as washing, dressing or cooking etc. It can also mean support to help a person get out and about in their community and to participate in the activities and hobbies that are important to them.

Unpaid carers are usually family members or friends who provide help and support to someone without being paid. There are also paid 'support workers' or 'carers' who are trained to provide care and support to adults with disabilities or health conditions, either in their own homes or within a residential care home. Carers who support people in their homes normally work through local care agencies, although they can also sometimes be employed directly by the person needing the care, and can sometimes be called 'personal assistants'.

The Adult Social Care team within a local authority is usually responsible for organising support for any adults living within their local authority area who need care and support. Social Workers are professionals who work with adults to find out what support they need and to help them to get it.

In Central Bedfordshire there is a special team of Social Workers who work specifically with young people who are transitioning into adulthood. They are the Young Adult and Independent Living Team (YAaIL) and they can be contacted on 0300 300 800 or by using this online form:

Adult Social Care Enquiry | Privacy Notice (centralbedfordshire.gov.uk)

Young Adult and Independent Living Team (YAaIL) | Central Bedfordshire SEND Local Offer

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Phase Transfer - moving on to a new school or college with an EHC Plan

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Phase Transfer - moving on to a new school or college with an EHC Plan

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When a young person is moving on to a new school or college this is called a 'Phase Transfer'.

In Central Bedfordshire, a Phase Transfer happens when your young person is moving from a secondary or upper school into post-16 education

If a young person has an EHC Plan they are entitled to ask for a place at any mainstream school or college, provided that:

The school or college is suitable for their age, ability and special educational needs

Their attendance at the school or college would not be incompatible with the education of other pupils at the school

A place at the school or college would be an efficient use of local authority resources - this condition means that the local authority does not have to provide a place at a more expensive school or college if there is another school or college that can also meet the young person's needs at a lower cost.

The Phase Transfer process begins in Year 10. In the summer term of this year you should receive an invitation to a 'Transfer Review Meeting' from your young person's school. The Transfer Review Meeting must be held before the end of the Autumn Term of Year 11. This meeting is your opportunity to say which new school or college you would like your child to transfer into. The Transfer Review Meeting must also act as an Annual Review of your child's EHC Plan to ensure that their Plan is amended where needed to include the most up-to-date information about them, ready for their move to their new school or college.

For young people in special school, the Transfer Review Meeting can still be held in Year 11 if they wish to move to other post-16 education rather than remaining at the special school.

The EHC Team will consider the new school or college that you have requested, together with any proposed updates to the young person's EHC Plan, and send you a new draft EHC Plan showing the name of the new school or college and any other amendments to the Plan that are needed. The EHC Team must do this by 31st March during Year 11.

The young person's current and new school or college should then start to plan for their transition, working closely with you to ensure that the change is as smooth and stress-free as possible. To help with this process, you can contact the SENCo at the new school or the Additional Learning Support Team at the college to talk to them about how best to help your young person during their transition.

If you disagree with the school or college that the local authority has named on your young person's EHC Plan you should contact the EHC Team to discuss this.

The EHC team | Central Bedfordshire SEND Local Offer

You have the right to appeal the local authority's decision with SENDIST by using this form:

Special Educational Needs and Disability Tribunal appeal: Form SEND35 - GOV.UK (www.gov.uk)

This appeal must be sent to SENDIST within two months of you receiving the new finalised EHC Plan.

More information about the Phase Transfer process for young people living in Central Bedfordshire can be found here:

Phased Transfers for children with an Education, Health and Care Plan | Central Bedfordshire SEND Local Offer

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(IPSEA) Independent Provider of Special Education Advice

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Moving to a new phase of education with an EHC Plan

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Apart from when an EHC plan is first issued, the move between phases of education is the most common time that parents, carers or young people have to think about what school or college should be named in the EHC plan. There should always be an annual review of the EHC plan before a transfer to a ne…

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Phase Transfer - moving on to a new school or college with a SEN Support Plan

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Phase Transfer - moving on to a new school or college with a SEN Support Plan

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All maintained schools and colleges have a legal duty under section 66 of the Children and Families Act 2014 to put in place the support that a pupil requires because of their special educational needs. This means that any support that a young person is receiving when they transfer to a new school or college must continue to be provided.

You can contact the school and ask to speak to the school SENCo or the Additional Learning Support Team at the college, to discuss your young person's needs and check what support is going to be put in place for them. If you feel that the support that they will be offering your young person is not going to be adequate, you can consider requesting an EHC Needs Assessment for your young person as the first step in securing an EHC Plan for them. Even though an EHC Plan may not have been necessary in a previous setting, it may sometimes become necessary in later phases of education. Find out more about requesting an EHC Needs Assessment here:

Assessment of SEND and EHC Plans in Educational Settings | Central Bedfordshire SEND Local Offer

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(IPSEA) Independent Provider of Special Education Advice

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Mainstream nurseries, schools and colleges

A child or young person who has SEN but no EHC plan must be educated in mainstream, subject to certain very limited exceptions (section 34 Children and Families Act (" CAFA") 2014). (See the section on types of schools for the definition of 'mainstream'.)

A school must not refuse to admit a child with SEN because they feel they do not feel able to cater for those needs. For more information, see the section on the right to mainstream .

Special units within mainstream schools are usually not special schools but part of the mainstream school to which they are attached. However, as places are often in demand and subject to demonstrable high levels of need, it's unlikely that a child or young person can access such provision without it being specified in an EHC plan. You can find more information on EHC plans here .

Finding out about SEN Support

Support for children and young people with SEN but no EHC plan will be through SEN Support (see the FAQs on how your nursery, school or college should help for information on what SEN Support should look like in each phase of education).

Under section 69 CAFA 2014, the governing bodies of maintained schools and maintained nursery schools in England, and the proprietors of Academy schools must prepare a report containing SEN information in the form of SEN Information Reports.

These SEN Information Reports (SIRs) must contain information about the kinds of special educational needs for which provision is made at the school; how children/young people with SEN are identified and assessed; how provision might be made for them and the effectiveness of such provision evaluated; and, how they support children/young people with SEND to engage in school activities.

This information must be published on the school website and is a valuable tool for looking at the kind of provision available.

Although sixth form colleges and FE colleges are not under the same obligations to produce SIRs, they should have information available on their policies and the support they offer.

Your local authority's (" LA's ") Local Offer (available on your LA website) should also contain useful information about the type of support available.

Ask to meet the person responsible for SEN Support in prospective schools/colleges and discuss with them what types of support might be available for the child/young person in question.

You can read more about how your nursery, school or college should support you here and about how your LA should support you here .

Moving to a new phase of education on SEN Support

Many LAs have worked with schools and colleges in their area to agree enhanced transition support for those children and young people who receive SEN Support and are moving to a new phase of their education. Information about this will be set out in your LA's Local Offer.

It may be that a greater level of support will be required once a child or young person moves to a new phase of their education. In such circumstances, it may be necessary to request that an EHC needs assessment is carried out.

When considering the need for an assessment or an EHC plan, the LA must look ahead to any upcoming move to a new phase of their education and whether this change of circumstance might make assessment or the issuing of an EHC plan necessary.

Special nurseries, schools and colleges

If a child or young person needs to attend a special school (or you think they may do) then it will be necessary to secure an EHC needs assessment and an naming this type of school or post-16 institution.

There are some very limited situations where children or young people can be placed in a special school or college without an EHC plan. These are:

while the child or young person is admitted to a special school or special post-16 institution for the purposes of an EHC needs assessment (or remains admitted to a special school or special post-16 institution, in prescribed circumstances, following an EHC needs assessment at the school or post-16 institution);

while the child or young person is admitted to a special school or special post-16 institution, following a change in his or her circumstances, but only where all of the LA, the head teacher or principal of the school or college, and the parents/carers or young person have agreed to such placement.

In addition, a child or young person can be admitted to a special school without an EHC plan if it is established in a hospital and is either a community or foundation special school, or an Academy school.

They can also be admitted, without an EHC plan, to a special school or special post-16 institution that is an Academy, if the Academy arrangements made in respect of the school or post-16 institution permit it to admit children and young people with special educational needs for whom no EHC plan is maintained. In the case of special Academies, parents or carers and young people need to be confident that the provision on offer is suitable to meet needs because there is no obligation on the LA to secure anything for them. It may be difficult, without identifying a child or young person's SEN through EHC needs assessment, to be certain if the placement and provision is right, in which case an EHC needs assessment should be sought.

If you haven't been able to find the answer to your question on this page, you can book an appointment to speak with us .

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Mainstream nurseries, schools and colleges A child or young person who has SEN but no EHC plan must be educated in mainstream, subject to certain very limited exceptions (section 34 Children and Families Act (“CAFA”) 2014). (See the section on types of schools for the definition of ‘mainstream’.)

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Creating a Hospital Passport for your child or young person can help them access their local hospital for check ups or treatment more easily. It can be given to hospital staff to let them know about your child's health conditions, their learning disability, how they communicate and what hospital staff can do to make things easier for them.

Showing staff a hospital passport will stop you having to explain the same information about your child again and again to different healthcare professionals. It can help your child or young person get the kind of care that works best for them.

It is always a good idea to have multiple copies of their hospital passport available so that it can be given to everyone who comes into contact with your young person whilst they are at the hospital.

More information about hospital passports can be found here:

Learning disabilities - Support if you are going into hospital - NHS (www.nhs.uk)

Click on the image above to look at one format for a Hospital Passport. Other formats can be found here:

healthcare-passport.pdf (england.nhs.uk)

Hospital Passport to fill in electronically.pdf (hscni.net)

download.cfm (royalsurrey.nhs.uk)

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The Care Act 2014 sets out what local authorities must do to support people with disabilities to be able to live the life that they choose in adulthood. This law sets out national rules that all local authorities must follow when they are assessing the needs of young people who are approaching adulthood or who have already turned 18. The Care Act describes when and how local authorities should provide the care and support that adults with disabilities need.

The full Care Act 2014 can be found here:

Care Act 2014 (legislation.gov.uk)

Find more information about The Care Act here and what it means here:

The Care Act | Mencap

CareActGuide24january2017.pdf (disabilityrightsuk.org)

The Care Act when transitioning from children's to adult social care - Special Needs Jungle

Care and support statutory guidance - GOV.UK (www.gov.uk)

The Care and Support (Eligibility Criteria) Regulations 2014 (legislation.gov.uk)

Care Act factsheets - GOV.UK (www.gov.uk)

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The Care Act - The Care & Support Process Explained - Webinar

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Pupils with SEND may qualify for extra help with their GCSE examinations. This could include your young person being given extra time to complete an exam, taking the exam in a different location or using computer to write or having someone else present to write for them. The rules about who qualifies for extra support are set out by the Joint Council for Qualifications (JCQ)

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(IPSEA) Independent Provider of Special Education Advice

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Pupils who have learning difficulties and disabilities may qualify for help in public examinations

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JCQ - extra support during exams for pupils with SEND

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JCQ - extra support during exams for pupils with SEND

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This document describes what kinds of support can be offered to pupils and what schools must do to facilitate these adjustments.

More information can be found here:

Access Arrangements, Reasonable Adjustments and Special Consideration - JCQ Joint Council for Qualifications

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Care and support that is provided in somebody's home is classed as non-residential care. If your young person continues to live with family carers as an adult, support workers can come into the home to help them with personal care, independent living skills, or to get out and about in their community. This care could be provided through a care agency or by a personal assistant employed directly by the young adult through the use of a direct payment or a personal health budget. Either way, if the young person is deemed to have eligible needs following a Care Needs Assessment, this support would be paid for by the local authority and/or the NHS (depending on their particular needs).

If your young adult needs support at their family home, it is worth considering how having carers within the home might impact other family members and how this might work for your particular family situation. Every young person and family situation is different, and so finding the right solution for them and for you as their family will be important. Carers can also be employed to come and help your young adult get out and about, to attend clubs or activities that are important to them or to support them to pursue their hobbies and interests.

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Whether your young person has an EHCP or a SEN Support Plan, the support for their special educational needs should continue into post-16 education, whether they are at college, sixth form or on a vocational learning or training course.

The SEN Code of Practice p111-119 explains what post-16 educational settings must do to support young people with special educational needs:

SEND_Code_of_Practice_January_2015.pdf (publishing.service.gov.uk)

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(IPSEA) Independent Provider of Special Education Advice

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Chapter seven of the SEN and Disability Code of Practice 2015 (the Code) contains the statutory guidance in relation to;

further education colleges

sixth form colleges

16 - 19 academies, and

some independent specialist colleges

to identify, assess and provide support for young people with SEN.

As young people, you should be supported to participate in discussions about your aspirations, your needs, and the support that you think will help you best. Support should be aimed at promoting your independence and enabling you to make good progress towards employment and/or higher education, independent living, good health and participating in the community.

SEN Support should follow a cycle of action:

Assess: Colleges should bring together all the relevant information from you, the school and anyone else working with you. This should be discussed with you and you can be accompanied by a parent, advocate or other supporter if you like.

Plan: A support plan should be developed together with you. Support might include assistive technology, specialist tuition, note takers, access to therapies (for example, speech and language therapy) or a range of other types of support.

Do: This plan should be put into place by the college.

Review: The effectiveness of the support should be reviewed regularly, taking into account your progress and any changes to your own ambitions and aspirations, which may lead to changes in the type and level of support.

External specialist help can be involved at any time, and should always be involved where your needs are not being met by the interventions put in place.

A record should be kept of the support provided and of your progress.

If the college has taken relevant and purposeful action to identify and meet your needs, but you are still not making expected progress, the college should consider requesting an Education, Health and Care needs assessment. You can also make this request yourself if you prefer, and your parents or other helper can support you in making it if you like.

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What does SEN Support in post-16 education mean?

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Chapter seven of the SEN and Disability Code of Practice 2015 (the Code) contains the statutory guidance in relation to; further education colleges sixth form colleges 16 - 19 academies, and some independent specialist colleges to identify, assess and provide support for young people with SEN.

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Disabled Students Allowance - extra financial support for students in higher education who have disabilities or other learning difficulties

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Disabled Students Allowance - extra financial support for students in higher education who have disabilities or other learning difficulties

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Help if you're a student with a learning difficulty, health problem or disability: How to apply - GOV.UK (www.gov.uk)

DSA Experiences - Dan's story (youtube.com)

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Ask SFE about applying for Disabled Students' Allowances - 2018/19

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Care Needs Assessment for social care funding in England - the rules and assessment criteria are the same for adults of any age

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Will my young person be eligible for care and support as an adult?

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Will my young person be eligible for care and support as an adult?

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The Care Act 2014 says that any adult (age 18+) is entitled to have ALL of their eligible support needs met by the local authority and/or the NHS if the following three conditions apply:

1. Their needs arise as a result of a physical or mental impairment or illness

2. They are unable to achieve at least two of the ten outcomes listed below without assistance

3. Not achieving these outcomes will have a significant impact on their wellbeing

Outcomes:

Managing and maintaining their nutrition

Maintaining their personal hygiene

Managing their toileting needs

Keeping themselves appropriately clothed

Using their home safely

Maintaining a habitable home environment for themselves

Developing and maintaining their family or other personal relationships

Accessing work, training, education or volunteering

Making use of community services, including public transport and recreational facilities

Carrying out caring responsibilities for their child if they have one

Any adult is regarded as being unable to achieve an outcome if they (i) cannot do so without assistance, OR (ii) trying to do so would cause them significant pain, distress or anxiety, OR (iii) trying to do so would endanger themselves or others, OR (iv) doing so takes them significantly longer than would normally be expected.

Your young person has the right to have a Care Needs Assessment and the local authority has a legal duty to assess them if they appear to have any level of need for care and support. The purpose of the assessment is to identify what help and support they will need as an adult and how this support might best be provided to them. The assessment is carried out by the YAaIL Adult Social Care team at the local authority (see above).

It is good idea to ask for a Care Needs Assessment for your young person when they turn 17, to ensure that there is time to put in place the care and support that they will need when they become an adult. If your young person already has a childrens' social worker, you can also contact them to ask for the assessment. Alternatively you can contact the YAaIL Adult Social Care team directly at Central Bedfordshire Council on

0300 300 8000

or start by completing this online enquiry form: Adult Social Care Enquiry | Privacy Notice (centralbedfordshire.gov.uk)

Your young person does not have to be receiving social care support as a child to request an adult Care Needs Assessment; you can still contact the YAaIL Adult Social Care team to ask for an assessment for their adult care and support needs.

More information about eligibility for care and support as an adult can be found here:

Getting a social care needs assessment | Disability charity Scope UK

CareActGuide24january2017.pdf (disabilityrightsuk.org)

Quick guide to eligibility outcomes under the Care Act 2014 - SCIE

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Care Needs Assessment for social care funding in England

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Reviewing an EHCP before moving into post-16 education or training 

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Reviewing an EHCP before moving into post-16 education or training 

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If your young person has an EHC Plan, this must be reviewed during the autumn term of Year 11 so it can be updated in readiness for them moving into post-16 education. The local authority must then send you a draft copy of the amended EHC Plan with the new school or college named on it, so that you can agree or comment on the amendments that have been made. The final version of the EHC Plan must then be sent to you by 31st March in Year 11.

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(IPSEA) Independent Provider of Special Education Advice

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CLICK TO DOWNLOAD: Annual reviews in advance of a transfer between phases of education (model letter 12)
What is a 'phase transfer'?

Local authorities (LAs) have a legal duty to review and amend an education, health and care (EHC) plan when a child or young person transfers from one phase of education to another.

Phase transfer is the moving between particular stages of education:

early years education to school

infant to junior school

primary to middle school

primary to secondary school

middle to secondary school

secondary school to a post 16 institution

For those transferring from secondary school to a post-16 institution, the EHC plan must be reviewed and amended by 31 March in the year of transfer.

For all other phases of transfer, the deadline is 15 February in the year of transfer.

When a young person is already attending a post-16 institute and it is proposed that they move from one post-16 institution to another at any time, the LA must review and amend the EHC plan at least five months before that transfer takes place.

These deadlines are set out in Regulation 18 of The Special Educational Needs and Disability Regulations 2014.

What this means is that after the review, the EHC plan should say that your child, or as a young person that you, will continue to attend the current setting until the end of the academic year (or another date if different). In Section I, it should name the setting or the type of setting that your child, or you, will attend from the start of the next academic year.

As described in more detail here , where your LA is amending (or changing) the EHC plan, it must:

Notify you as the parent or young person of its decision within four weeks of the meeting.

Send to you a draft of the proposed amendments together with the decision letter , so that you can make comments on the content of the EHC plan.

Finalise the amended EHC plan within eight weeks of sending to you the proposed amendments.

Complete this process by the deadlines set out above. This means that discussions about transfer need to begin early in the autumn term of the year before transfer to allow plenty of time for the review and amendment process to happen.

What if the LA has not started the annual review process on time?

If you haven't been notified that a review of the EHC plan is going to take place by the autumn term, you can write to the LA using our model letter.

Who should I write to?

You can use this letter to write to the top person at the LA, usually the Director of Children's Services. You can find this information and contact details for this person online. It may help to copy in the LA's monitoring officer, your ward councillor, and the LA case worker or officer you have been dealing with as well.

Your LA's Local Offer should clearly set out how a formal complaint can be made in its complaints procedure. This can be found on your LA's website. You should follow the LA's complaints procedure as well as writing to the Director of Children's Services. See our making a complaint about a LA page for more information.

Remember to keep a copy of any letter or email you send.

If you don't get a reply after five working days, or if you need further advice, you can book an advice line appointment with IPSEA.

If you haven't been able to find the answer to your question on this page, see our .

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Annual reviews in advance of a transfer between phases of education: Model letter 12

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CLICK TO DOWNLOAD: Annual reviews in advance of a transfer between phases of education (model letter 12) What is a ‘phase transfer’? Local authorities (LAs) have a legal duty to review and amend an education, health and care (EHC) plan when a child or young person transfers from one phase of education to another.

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Reviewing an EHCP before moving into Post-16 education or training - The law

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Reviewing an EHCP before moving into Post-16 education or training - The law

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The Special Educational Needs and Disability Regulations 2014 set out when and how an EHCP should be reviewed before a young person transitions into a new school or college.

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Circumstances in which a local authority must review an EHC plan

18.-(1) Except where paragraph (3) applies, where a child or young person is within 12 months of a transfer between phases of education, the local authority must review and amend, where necessary, the child or young person's EHC plan before-

(a) 31 March in the calendar year of the child or young person's transfer from secondary school to a post-16 institution; and

(b) 15 February in the calendar year of the child's transfer in any other case,

and where necessary amend the EHC plan so that it names the school, post-16 or other institution, or type of school or institution, which the child or young person will attend following that transfer.

(2) Where it is proposed that a young person transfers from one post-16 institution to another post-16 institution at any other time, the local authority must review and amend, where necessary, the young person's EHC plan at least five months before that transfer takes place so that it names the post-16 institution that the young person will attend following the transfer.

(3) Where a child or young person is due to transfer from a secondary school to a post-16 institution on 1 September 2015 the local authority must amend and review the EHC plan under paragraph (1)(a) before 31 May 2015.

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The Special Educational Needs and Disability Regulations 2014

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These Regulations supplement the procedural framework assessing a child or young person with special educational needs, and the procedure for making, reviewing, amending and ceasing to maintain an EHC plan, set out in Part 3 of the Children and Families Act 2014 ("the Act").

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Will my young person lose their EHCP at 16?

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Will my young person lose their EHCP at 16?

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Your young person's EHC Plan does not end at age 16, but should continue until age 25 as long as they still have special educational needs and they are still in some kind of education or training (excluding higher education e.g. university).

The local authority can only take away a young person's EHC Plan if:

The young person's special educational needs have changed and no longer require the provision set out in the plan. However, if the outcomes in the EHCP have not been met then the EHCP should continue and the provision amended

The local authority is no longer responsible for the young person because they have moved to a different local authority area

The young person has left any kind of education (this can only be the case once they reach age 18)

The young person has moved into higher education e.g. university

The young person has reached age 25

The young person is in paid employment

More information and advice can be found here: If your LA takes away your EHC plan | (IPSEA) Independent Provider of Special Education Advice

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SEN Legal Webinars - Ceasing to Maintain an EHC Plan

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Education beyond 16 for young people with SEND

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Education beyond 16 for young people with SEND

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Post-16 education does not only have to be school or college. It could include work experience, volunteering or self-help skills. Click this image to find out more about the options to consider.

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Who will carry out the Care Needs Assessment for my young person?

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Who will carry out the Care Needs Assessment for my young person?

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The Young Adult and Independent Living Team (YAaIL) works within Adult Social Care team at Central Bedfordshire Council. The YAaIL Team are responsible for supporting young people with disabilities as they approach age 18, and for organising the care that they need as adults.

A social worker from the YAaIL Team will carry out the Care Needs Assessment of your young person to determine what their eligible needs will be in adulthood and how the support that they require can be provided. The YAaIL Team must listen to the wishes and views of the young person, and take into consideration your views as their family carer.

The YAaIL Team can be contacted to request a Care Needs Assessment for your young person on 0300 300 8000 or you can use their online enquiry form: Adult Social Care Enquiry | Privacy Notice (centralbedfordshire.gov.uk)

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What changes can I expect when my child turns 16?

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What changes can I expect when my child turns 16?

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When a young person reaches 16 years old, some things can change for them. This can include changes to their benefits, their education, and their employment opportunities. The following sections in this guide will help you understand what these changes are.

During Year 11 young people are making decisions about their post-16 future and whether to stay in education or to move into supported employment, work or other training. The sections below will help to explain some of the educational support and options available, as well as other issues relating to turning 16.

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Supported-living is a type of non-residential care. It allows adults with disabilities to live separately from their family within a home that they rent for themselves. This might be living on their own or with others. In a supported-living setting they would have their own tenancy agreement just like any other adult, usually living within council housing, a housing association property or by renting from a private landlord.

Support staff come into their home to support them with whatever aspects of their life they need help with. This care might be provided by a care agency who organise staff to work at the person's home to support them, or by a personal assistant paid for from the person's direct payment or personal health budget. In supported-living the young adult may need help to manage their own finances, and this support can be given by a family member or by their support worker, to help them manage their household bills and expenses.

The amount of support that they receive in their home will be based on their particular needs and will be set out in their Care and Support Plan. For some adults this care might be for just an hour each day, whilst others might need high levels of support for 24 hours a day.

Unlike residential care, the care and support that the adult receives in their home is not tied to the home itself. They are able to change who provides their care and support without moving out of their home.

Some organisations that provide non-residential care within supported-living settings, can also help your young person find their own property to rent either through a housing association or with private landlords who rent specifically to people with disabilities. They may also have support-living homes that have vacancies, to allow your young person to join a existing shared home.

Many adults with disabilities will receive housing benefit or universal credit which can pay for the rent on their home. Although they will still be financially assessed and may need to make a contribution towards the cost of their care and support, they should always be left with enough money to pay for their living expenses and to live an independent and active life.

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Student finance for Higher Education (University and other level 4 courses)

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Student finance for Higher Education (University and other level 4 courses)

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What happens after my young person has had their Care Needs Assessment?

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What happens after my young person has had their Care Needs Assessment?

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If the assessment of your young person determines that they do have eligible care and support needs, Central Bedfordshire Council must prepare a Care and Support Plan for them which sets out all of the support that they will receive and who will provide it. The Care and Support Plan must reflect the wishes and aspirations of the adult by listing the outcomes that they want or need to achieve, and say how the care and support will help them do this.

If the Council decides that your young person does not have care and support needs, they should still provide you with information about other local services and support that can support your young person in adulthood. If you disagree with the outcome of your young person's Care Needs Assessment, you should first make a complaint to the Council here: Customer feedback | Central Bedfordshire Council If you are not happy with the outcome of your complaint to the Council you can also refer the matter to the Local Government and Social Care Ombudsman: Home - Local Government and Social Care who can provide an independent person to look into your complaint.

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Care and Support Planning and The Care Act

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The Care and Support Plan: what should it include?

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The Care and Support Plan: what should it include?

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Attending college does not have to mean studying for traditional post-16 qualifications. Most local colleges also offer courses in foundation and life skills that are targeted towards young people with learning disabilities. These courses provide specialist support for learning social, personal and independent living skills.

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What can I do next?

Student Success
Students receive a high level of support to promote their personal development and progress them into further education, independent living, volunteering or paid employment.
A number of our students have progressed into mainstream education in a variety of subjects following their Foundation programme, including: Animal Care, Business, Creative Art, Media, Performing Arts, and Sport.

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Foundation Education | The Bedford College Group | Further and Higher Education

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Our Foundation Skills Programme is aimed at young people with identified learning difficulties and/or disabilities. The programme enables students to develop their social, personal, employability and independent learning skills within a supported environment.

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When a young person reaches the age of 16, by law they are then entitled to begin making some decisions for themselves independently of their parents or carers. This might include decisions such as consenting to medical treatment, deciding where they will live, claiming benefits in their own name or making financial decisions.

However, where a young person is not able to make some or all decisions for themselves because of their additional needs or disabilities, the Mental Capacity Act (MCA) allows others to make these decisions for them. The MCA requires that every possible support must be offered to the young person first to allow them to make a decision for themselves, but where this is not possible others are then able to make the decision on their behalf and in their best interests.

Until a child reaches age 18, parents still have legal rights and responsibilities for their child which is called 'parental responsibility'. Having parental responsibility means that parents and carers can still make many decisions for their child until they turn 18, although a clear definition of exactly which decisions fall within 'parental responsibility' is still not clearly described within the law.

After the age of 18, any decisions that are made for the young adult should be made in their best interest by everyone involved in their care. This must include their family members who should be fully involved in any decisions that are made.

Once a young person has turned 18, family members can apply to the Court of Protection for Deputyship, to be granted the legal right to act on behalf of their young adult and make decisions for them. Please see later sections of this guide for more information about Deputyship.

Find more information about the Mental Capacity Act and parental responsibility here:

Parental responsibility & mental capacity beyond 16 | Contact

Mental Capacity Act - Social care and support guide - NHS (www.nhs.uk)

What is The Mental Capacity Act? | Mencap

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How will the care and support for my young person be provided when they are an adult?

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How will the care and support for my young person be provided when they are an adult?

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Your young person's Care and Support Plan will set out what kind of support they need and when this help needs to be provided for them.

The local authority can organise this care and support for them by paying a local care agency to provide the carers that your young person needs. You and your young person should still be consulted by the care agency to ensure that the carers that they send to help your young person are the right fit for them. Carers usually come on set days and times as detailed in the Care and Support Plan.

Alternatively, instead of the local authority organising the care for your young person, you can ask for them to have a Direct Payment. This is an amount of money that is paid to either the young person themselves, or to a family member, to allow them to find and employ their own carers, or to pay a care agency themselves. This money must be kept in a separate bank account and only used to provide the care and support that is included in the young person's Care and Support Plan. Having a Direct Payment means that the money can be used more flexibly, allowing the amount or type of care to change at different times in a way that best meets the needs of the young person.

More information about Direct Payments for people living in Central Bedfordshire can be found here: Local Forms & Leaflets – Central Bedfordshire APPP Resource (centralbedsappp.co.uk)

Direct payments: adults and older people | Central Bedfordshire Council

What is a Direct Payment?

ER1-Direct-Payment-Final.pdf (centralbedsappp.co.uk)

Support Planning & Money

ER2-SupportPlanning-Final-2024.pdf (centralbedsappp.co.uk)

Support Options

ER3-Direct-Payment-Support-2024.pdf (centralbedsappp.co.uk)

Things you will need to do

ER4-DP-Responsibilities-Final.pdf (centralbedsappp.co.uk)

Training a Personal Assistant

ER6-PA-training-Final-2024.pdf (centralbedsappp.co.uk)

How to Complain about your support

ER5-Complaints-Final.pdf (centralbedsappp.co.uk)

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Gofal Cymdeithasol Cymru / Social Care Wales

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Social worker Lucy Powell introduces direct payments to help meet an individual's well-being outcome

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The video explains more about the Mental Capacity Act (MCA) and the rules around how decisions can be made for someone who can not make them for themselves.

The Mental Capacity Act Code of Practice should be followed by everyone involved in the care of a person who lacks the capacity to make some or all decisions for themselves. The Code can be found here: Mental-capacity-act-code-of-practice.pdf (publishing.service.gov.uk)

Click the links below for more information about the Mental Capacity Act 2005:

What is the Mental Capacity Act? - Mind

Mental Capacity Act 2005 (legislation.gov.uk)

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The Mental Capacity Act: an animated guide by Infodeo.

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Please give us your feedback about the information within this guide

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Please give us your feedback about the information within this guide

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At the bottom of each information section, you can click on the star symbol to rate how useful that section was for you and your family.

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Young adult clubs and activities in and around Bedfordshire

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Young adult clubs and activities in and around Bedfordshire

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Participating in community leisure activities and making friends is an important part of adulthood. Opportunities to do so should be included as part of your young person's Care and Support Plan when they are an adult. The cost of community activities and the transport needed to get to them could be included as part of the Plan for their care and support.

Some local activities for adults with disabilities within Bedfordshire and neighbouring counties are listed below.

Support for Adults » Autism Bedfordshire

Young Adult Club - Age 18 to 25 years - Families United Network

Adult Club - Age 26 to 35 years - Families United Network

Adults Skills Workshop - Families United Network

Adult Sensory Movers | Spectrum CA

Adult Movers | Spectrum CA

Search local groups | Mencap

Day Centre - Cottons Farmhouse

The Cube Disability

The Inclusion Project - Learning Disabilities, Learning Difficulties

About Electric Umbrella

Riverside Tennis Club / #NoBarriers: Open Court Disability Tennis at Riverside (lta.org.uk)

About | BDHRA

Music therapy and learning disabilities — Music24

Adult Services — Grow Wild

Home Grown Care Farm

SENsational Care Provisions | Northampton | Facebook

The 3H Foundation supports people with disabilities and carers.

Day Centre | CYCD

DSUK Milton Keynes Group (disabilitysnowsport.org.uk)

Disability - Bedfordshire FA

Social Link Evening Clubs (sociallinkcharity.org.uk)

Social Link Day Projects | Day Project Sessions (sociallinkcharity.org.uk)

Charitable Organisation | Living It Up Events | Bedford (lovelivingitup.org)

Book club (autism.org.uk)

HOME | Swirl Nightclub (darren6421.wixsite.com)

Special Needs Events (djdanblaze.com)

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Biggleswade Centre

London Road
Biggleswade
Bedfordshire
SG18 8HA

What we do in Biggleswade

We offer a range of centre and community-based activities for customers with a learning disability, including those who have profound and multiple learning disabilities.

Currently we operate between 9am and 4pm Monday to Friday. All customers are encouraged to tell us what activities they would like to get involved in and we try to provide these wherever possible.

Examples of activities we currently offer include arts and crafts, sport, culture, horticultural, and music sessions, both within the centre and out in the community.

With the support of staff, customers run community coffee shops in the local area as well as a lunch service for those attending the centre.

Townsend Centre

Portland Close
Houghton Regis
Bedfordshire
LU5 5AW

What we do at Townsend Centre

We offer a range of centre and community-based activities for customers with a learning disability, including those who have profound and multiple learning disabilities.

Currently we operate between 9am and 4pm Monday to Friday. All customers are encouraged to tell us what activities they would like to get involved in and we try to provide these wherever possible.

Examples of activities we currently offer include arts and crafts, sport, culture, horticultural, and music sessions, both within the centre and out in the community.

With the support of staff, customers run community coffee shops in the local area as well as a lunch service for those attending the centre.

We also run a satellite service known as the Communities Opportunities Group (COG) in Leighton Buzzard three days a week. The focus is community participation which currently includes weekly tennis coaching at the local tennis club.

Silsoe Horticultural Centre

Holly Walk
Silsoe
Bedfordshire
MK45 4EB

At Silsoe Horticultural Centre we support people with learning disabilities to be engaged in a range of centre and community-based activities from our beautiful three-acre site.

The people we support can follow two different pathways of support.

Pathway for employment and volunteering

Provides people with the training and specific support to develop employment skills to move to employment or volunteering opportunities.

Wellbeing pathway

Provides the people we support with a chance to enjoy the benefits of therapeutic horticulture and other activities to enhance their social and emotional and physical wellbeing.

We offer work experience and informal training in horticulture, woodwork, crafts and in our Potting Shed Café and kitchen.

Our onsite horticultural activities provide people with the opportunity to get involved with all aspects of gardening, including:

growing and harvesting kitchen garden produce

growing ornamentals and cut flowers, planting hanging baskets and potted arrangements

site development and garden management

building wooden planters and small wooden constructions

customer service, in our on-site produce shop

making garden and seasonal crafts

Our on-site café and kitchen provides people with a space to take part in:

the preparation and production of a range of preserves such as chutneys and jams

learning how to prepare and cook a wide range of dishes

preparing and serve home cooked dishes for our onsite café

customer service skills training

In addition to our onsite activities, we offer people the chance to get involved in our community partnerships.

Currently we work with Whipsnade Zoo in developing its community garden and growing a range of vegetables and flowers.

Our outreach gardening project works with council run homes in the development and maintenance of their gardens. These partnerships empower the people we support to use their gardening skills and benefit from social and therapeutic horticulture.

Our produce shop is open Monday to Friday between 10:30am and 2:30pm where we offer for sale to the public the items we grow and create.

The Potting Shed Café is open each week on a Thursday between 10:30am and 2:30pm and provides the opportunity for the people we support to develop skills in food catering and customer services.

To find out more about and how you can get involved please contact us on 0300 300 4641 or alternatively our Adult Learning Disability Team on 0300 300 8100.

The future day offer for older people and adults with disabilities

We're currently working to improve and enhance the day services available to older people and adults with disabilities in Central Bedfordshire.

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Learning disabilities | Central Bedfordshire Council

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A learning disability can affect the way a person learns new things in a range of different life areas. It can affect the way a person understands information and how they communicate

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If I choose to continue to provide some or all of the care that my young person needs when they are an adult, what help can I expect?

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If I choose to continue to provide some or all of the care that my young person needs when they are an adult, what help can I expect?

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You can choose to continue to provide some or all of the care and support to your young person after they are 18 if you are both willing and able to do so. If you choose to provide this care, you are entitled to ask for a Carers Assessment. The Care Act 2014 says that the Council must assess your own needs for support to help you in your caring role. This means that someone from Central Bedfordshire Council will talk to you to find out how your caring role impacts your life, and what support you need to continue to be able to provide some or all of the care that your family member needs. The Council must then draw up a plan to say how they will support you as a carer e.g. helping you to juggle work and care, providing you with a break from caring, providing information about local support groups, or equipment to help you in your caring role.

You can ask for a Carers Assessment at any time by contacting the Central Bedfordshire Adult Social Care Team on 0300 300 8000 or by submitting an online enquiry here Adult Social Care Enquiry | Enquiry (centralbedfordshire.gov.uk)

There is no charge to have the assessment and you don't need the permission of the person you are caring for.

More information about Carers Assessments can be found here:

Carer's assessment | Carers UK

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Some young people with an EHC Plan may require specialist further education provision. Find out about providers across the UK here.

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Look for one of our member colleges using the search tools. If you already know the name of the college that you're looking for, view colleges listed alphabetically

By Geographical Area

If you would prefer to search by area, please use the map below.
Zoom in or out by clicking the + or - buttons on the left and move aound the map by clicking the arrows. To view the college details, left click on a marker.
Indicates colleges offering residential and day provision Indicates colleges offering day provision only Indicates colleges' satellite provision
By Area of Expertise

If you would prefer to search for colleges by their area of expertise, please use the list below. Once you have selected an area, please click the 'Submit' below

College Directory

We produce a directory of our member colleges which you can view online or in print.

share this page:

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Search for one of our member colleges by location or by expertise.

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Will my young person have to pay for the care and support that they receive as an adult?

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Will my young person have to pay for the care and support that they receive as an adult?

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The local authority will carry out a financial assessment of your young person to see if they are required to make a contribution towards the cost of their care and support as an adult. This assessment is based on the assets, income and expenditure of the young person, and is not affected by the assets or income of their family members, carers or anyone else they live with.

How much your young person will have to pay depends on whether they are being cared for within a residential care home or not. Further information about the charging differences for residential and non-residential care can be found in the next section of this guide. But below are the relevant guides for Central Bedfordshire:

Paying for non-residential care: Paying-for-non-residential-care-leaflet-1.pdf (centralbedsappp.co.uk)

Paying for residential care: Paying-for-residential-care-leaflet.pdf (centralbedsappp.co.uk)

Most young adults with disabilities will not have significant assets of their own, and so any contribution that they make will most often be based solely on their benefit income. Any extra costs they they have because of their disabilities will also be taken into account.

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Thurrock Adult Social Care - paying for care

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Ready, Steady, Go is a programme designed to help young people transition from childrens to adult health services, and to support them in their learning and understanding about their conditions.

The Ready, Steady Go programme provides easy read versions of its resources which can be found here:

Moving into Adulthood booklet:

ready-steady-go-programme-easy-read-booklet-2459-patient-information.pdf (readysteadygo.net)

'Ready' questionnaire:

easy-read-ready-3.pdf (readysteadygo.net)

'Steady' questionnaire:

easy-read-steady-3.pdf (readysteadygo.net)

'Go' questionnaire:

easy-read-go-3.pdf

Ask your clinician or health professional about this programme if you feel it may be helpful for your child.

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EHCP Annual Reviews in Year 9 and beyond

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EHCP Annual Reviews in Year 9 and beyond

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Every Annual Review of your child's EHCP from Year 9 onwards must include planning for their transition into post-16 education and into adult life more generally. It must include their choices and wishes for their future education, work or training; whether they want to move out of home and live independently; how they want to access their local community and make/maintain their friendships; and what they need as they move into adult health services.

Your child's EHC Plan should be updated at the Year 9 Annual Review to include their wishes about any or all of these things, and clearly lay out their aspirations for their future as a teenager and as an adult. From the Year 9 Annual Review, their EHC Plan must include outcomes which help them to prepare for the future life that they choose. Parents and carers must also be given an opportunity to express their views and thoughts about their child's future and should be included as part of the planning process for their child at every stage.

Your young person's choices about their future may change during their teenage years and so their aspirations and outcomes should be reviewed each year at their EHCP Annual Review meeting and amended as needed, so that the Plan always accurately reflects their wishes and the planning that is needed for the future life that they want.

Ask the SENCO at your child's school or college how they are going to be looking at preparing your young person for adulthood from their Year 9 Annual Review? How will they be including your child's views and wishes about their future life within their EHCP? If your child receives social care support (short breaks and respite provision), who from children's social care will be attending or contributing to your child's Annual Reviews from year 9? Have any key health professionals that your child sees been invited to contribute to the Review? If you feel that your child's EHCP or their Annual Review does not include the Preparing for Adulthood focus that it should, you can contact the EHC Team at Central Bedfordshire Council:

The EHC Team 0300 300 8356 ehcreviews@centralbedfordshire.gov.uk

You can also contact your local SEND advice service for help and support:

SENDIASS 0300 300 8088 support@sendiass.co.uk

You will find more information about SENDIASS and the help that they can offer in the section below.

More information about EHCP Annual Reviews from Year 9:

Key-Topics-Annual-Review.pdf (ndti.org.uk)

Year-9-Annual-Review-Guide.pdf (ndti.org.uk)

Annual reviews in Year 9 and beyond | (IPSEA) Independent Provider of Special Education Advice

What is an Education, Health and Social Care (EHC) plan? (updated 2019) (youtube.com)

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Special Educational Needs and Disabilities Information Advice and Support Service (SENDIASS) 

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Special Educational Needs and Disabilities Information Advice and Support Service (SENDIASS) 

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About - Central Bedfordshire SENDIASS (cbsendiass.org)

SENDIASS is a free information, advice and support service that can help with issues related to Special Educational Needs and disability. They can help by offering you:

confidential support and someone to talk to in confidence

information and advice about:

Special Educational Needs support in the education setting

Education health and care (EHC) needs assessment process

EHC plans and annual reviews

Appealing to the SEND tribunal

Exclusion processes

listen to your views and concerns

work with you to explore your options

help you prepare for meetings

support you to find the confidence to express your views

work in partnership with education settings, the local authority and other services to develop positive relationships

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Introduction to the Information Advice and Support Service

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What should happen before, during and after my child's EHCP Annual Review?

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What should happen before, during and after my child's EHCP Annual Review?

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Find more help here:

Central Bedfordshire SENDIASS - Central Bedfordshire SENDIASS (cbsendiass.org)

ARtimetable.cleancopy.final.pdf (councilfordisabledchildren.org.uk)

ARfactsheets.general.cleancopy.FINAL_0.pdf (councilfordisabledchildren.org.uk)

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Education, Health and Care Plan Annual Review Animation

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Personal Budgets, Direct Payments & Financial Assessments explained

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Personal Budgets, Direct Payments & Financial Assessments explained

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Although this video references another Council, the information provided is the same for most local authorities.

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What is 'Person-centred planning' and what should this look like for my child or young person?

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What is 'Person-centred planning' and what should this look like for my child or young person?

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Person-centred planning should put the young person and their families at the centre of any decisions that are made. Every decision should be based on the young person's wishes and hopes for their future and on the things that actually make life worth living for them.

What good support actually looks like for the young person should be clearly understood by everyone involved in their care and support, whether this is at school or college, at leisure or community activities, or at health settings like GP surgeries, hospitals or clinics.

Personalisation in Social Care:

What is personalisation (youtube.com)

NHS Personalised Care Model:

NHS England » Comprehensive model of personalised care

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The EHC plan and The Person Centred Connection (updated 2019)

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The SEND Code of Practice explains what support the local authority and schools/pre-schools/colleges must provide for children and young people with special educational needs or disabilities at any age from birth to 25 years.

The guidance describes how and when a child is assessed for an Education Health and Care Plan (EHCP) and what support this Plan should provide for them.

Chapter 8 of the SEND Code of Practice sets out what different professionals across education, health and social care should be doing to help your child prepare for adulthood.

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Transitioning into adulthood for those young people with challenging behaviour

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Transitioning into adulthood for those young people with challenging behaviour

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This guide helps to explain different care options and where to get help and support to access them.

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If you or someone you know needs help with day-to-day living because of illness or disability, this website explains your options and where you can get support.

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A residential care home is usually a shared house where adults with disabilities live and receive the care that they need. The care and support provided is linked to the home in which they live and provided by the same organisation, so they do not have there own tenancy agreement or receive housing benefit. The local authority and/or the NHS pay one set fee which covers all of the young person's accommodation costs, living expenses and their care and support. The care provided within a residential care home is usually for those with more complex or nursing care needs, and the home environment will often include more specialist facilities and equipment. Residential care homes should still support adults to access education or community activities, and may provide a schedule of onsite activities for the adults living there.

In some respects a residential care home for younger adults may look and feel similar to supported-living. However, as the home and the care are linked, it is not possible to change care provider without moving to another home. The financial contributions that the adult will pay towards their care are also different, as explained in a later section.

Find more information about care homes for younger adults here:

Care homes for younger adults (under 65)

Younger Adults Care Homes / Nursing Homes England | 66321 Reviews

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All the Different Types of Care Homes in the UK: carehome.co.uk

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SNAP PCF are the Parent Carer Forum for Central Bedfordshire. If you have a young person aged from birth to 25 years who has additional needs or disabilities, and you live in Central Bedfordshire or your child accesses services within Central Bedfordshire, you can join the Forum.

Get involved, share your experiences (good or bad!) and have your voice heard by joining SNAP: Get Involved - SNAP PCF - Central Bedfordshire

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Find our more about what Parent Carer Forum's do:

What is a Parent Carer Forum and what do they do (youtube.com)

What is Co-production and what difference should it make to children and families?

Co production Subtitled (youtube.com)

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Parent carer forum online learning from Contact

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Why should I join my local Parent Carer Forum for Central Bedfordshire?

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Why should I join my local Parent Carer Forum for Central Bedfordshire?

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Get involved, share your experiences (good and bad!) and have your voice heard within Central Bedfordshire by joining SNAP:

Get Involved - SNAP PCF - Central Bedfordshire

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Making a Difference   Why should I join my local Parent Carer Forum

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Education, Training and Supported Employment (incl. transport assistance)

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Education, Training and Supported Employment (incl. transport assistance)

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A major step for a young person on their path towards adulthood can be moving into post-16 education, higher education or leaving school altogether.

The information in these sections will help you understand the support your young person can receive when moving on to college or into supported employment or other training. It will highlight what options and support are available for post-16 education, training or work. These sections will also help explain whether a young person can get help with transport to school, college or training after the ages of 16 and 18.

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Leaving children's health services and having to get to know new adult health professionals, departments and services can be daunting.

These sections highlight what health services should be doing and when, to help children move from children's to adult health services without their being any gap in their care.

The information in these sections is about getting the right help and support to manage physical and mental health conditions and disabilities in adulthood.

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Moving into adulthood is also about moving from children's social care into adult social care, and how the eligibility for care and support changes at age 18.

These sections will explain what support your young person might receive for daily-living and leisure activities (outside of school, college or other education) as they get older and move into adulthood. This information aims to help you understand what social care support a young person might get after age 18 and who provides this. It will help you understand how the role of family caregivers can change when your child turns 18, and what your new rights as their carer are. It will explain the eligibility criteria for adult support and how and when your child can be assessed for getting the support that they need as an adult.

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This information is about entitlement to benefits and help with managing finances as an adult. This section highlights how benefits can change after age 16, and after age 18. It will explain what contribution adults who are receiving social care support may have to pay towards the cost of this care.

These sections also explain what extra financial help may be available at colleges or university for young people and young adults with SEND.

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Look for these sections to find out about support to help your young person move out of home and live independently. It will help you understand the different housing and support options that are available for younger adults, and how to go about finding the right independent living setting for your young person.

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School Transport: helping your child get to and from school

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School Transport: helping your child get to and from school

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Local authorities have a duty to provide transport to and from school for some pupils with special educational needs or disabilities where, because of their disabilities, the normal statutory walking distances do not apply.

Whether the local authority has to provide school transport will depend on your child's age, the school they attend, and what their particular needs and difficulties are.

Applications for school transport can be made annually, and give you the opportunity to provide evidence to show why your child needs school transport even if they live within the statutory walking distances (under age 8 this is 2 miles; age 8 to 16 is 3 miles)

If you live within the statutory walking distance but you think that your child or young person's special educational needs mean that they need help to get to school, you can find more information and apply for school transport for your child here:

Apply for school transport | Central Bedfordshire Council

You can also contact the Central Bedfordshire School Transport team on 0300 300 8339

Other help and support:

SENTAS – Special Educational Needs Transport Advocacy Service

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(IPSEA) Independent Provider of Special Education Advice

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Local authorities (LAs) are required to arrange free, suitable, home to school transport for children of compulsory school age who are 'eligible', to their nearest suitable qualifying school (section 508B of the Education Act (EA) 1996).

Eligible children fall within four groups, set out in Schedule 35 EA 1996:
Children with SEN, a disability or a mobility difficulty Children whose route to school is unsafe Children who live beyond the statutory walking distance Children from low income families
Follow the links above to find out more information about each category.

If your child meets the criteria for any one of these categories, they should be entitled to home to school transport. For example:

If your child is eligible for free home to school transport due to their SEND, it does not matter whether they live within statutory walking distance - they will still be eligible for transport.

If your child is eligible under one of the 4 categories, then also being eligible for disability living allowance or having access to a Motability vehicle is not relevant to a disabled child's eligibility for free travel to school (except as evidence of their disability) - they will still be eligible.

If your child is eligible for free home to school transport due to their SEND, there is no requirement for them to have an EHC plan or attend a special school.

A qualifying school is a:

maintained (publicly funded) school or nursery

non-maintained special school

pupil referral unit

city technology college

an alternative provision Academy, or

an Academy

If your child has an EHC plan and attends an independent school , their independent school can also be a qualifying school if this is the only school or the nearest school named in Section I of your child's EHC plan (Paragraph 15(3) Schedule 35B EA 1996).

Your child may also be eligible for free travel to a place that isn't a qualifying school:

where they receive education at a place other than a school under section 19(1) of the EA 1996 (which requires LAs to make arrangements for the provision of suitable education for children of compulsory school age who would otherwise not receive suitable education for reasons such as illness or exclusion), or

where they are suspended (temporarily excluded) from a school (but remain a registered pupil of that school) and attend an educational establishment that is not a qualifying school and is not within the statutory walking distance of their home, then that educational establishment is treated as if it were a qualifying school for the purposes of eligibility for free travel.

Schools should also work with the LA when arranging educational provision for a child during a suspension where the pupil might be eligible for free travel to the place where they will be receiving education.

What are travel arrangements?

"Travel arrangements" are defined in section 508B(4) EA 1996 and paragraphs 61 - 69 and part 3 of the government's statutory guidance 'Travel to school for children of compulsory school age 2024' .

'Home to school travel arrangements', in relation to an eligible child, are travel arrangements in both directions between your child's home and the relevant educational establishment.

They include arrangements for the provision of transport, and any of the following arrangements - but only if they are made with your parental consent:

provision of one or more escorts (whether alone or together with other children) when travelling to or from the relevant educational establishment

payment of the whole or any part of a person's reasonable travelling expenses

payment of allowances in respect of the use of particular modes of travel, and

voluntary arrangements made by you.

Travel arrangements in relation to an eligible child must not give rise to additional costs and must include appropriate protection against those costs.

The Travel to school for children of compulsory school age 2024 Guidance (paras 81 - 85) defines suitable travel arrangements. It highlights that LAs must make sure that the travel arrangements they make take account of the needs of the child concerned. For example, it would not be appropriate to provide a pass for free travel on a service bus to your child if their special educational needs mean they would be unable to travel on a service bus.

In particular:

The arrangements should allow your child to travel without undue stress, strain or difficulty, so that wherever possible they arrive at school ready to learn.

They must allow your child to travel in reasonable safety and comfort, although this does not necessarily mean a door-to-door service. However, your child's needs may mean they need to be collected from their home, and your LA should not have a policy that it never provides door-to-door transport and should make decisions on a case-by-case basis.

Your child's needs may need to be reassessed from time to time, for example if their level of need changes or if they move to a new school. Some children with special educational needs can find change distressing. Your LA should provide you with as much notice as possible of any changes to your child's travel arrangements.

The guidance suggests maximum reasonable journey times of 45 minutes for primary school children, and 75 minutes for secondary school children. These maximum journey times include any time taken to walk to a pick-up point. It notes, however, that for children with SEN and/or disabilities, journeys may be more complex and a shorter journey time, although desirable, may not always be possible. Your child's age and disability would have to be taken into account in considering what is suitable. Breaks might be needed when children live a long way from their school. Where long journeys are unavoidable, LAs should consider whether there are measures they can take to minimise negative impacts for your child.

Safeguarding and training

LAs should make sure that:

an enhanced Disclosure and Barring Service (DBS) check, with a check of the children's barred list, has been carried out for drivers and passenger assistants involved in providing dedicated school transport

drivers and passenger assistants have received any training they need to perform their role in relation to safeguarding

drivers and passenger assistants know how to report any concerns they have about the children in their care, and

LAs share any concerns they have about the driver of a taxi or private hire vehicle with the authority that licenses them, and consider whether concerns they have about a driver should be referred to the DBS.

LAs also need to make sure that drivers and passenger assistants working on dedicated school transport have undertaken appropriate training and that this is kept up to date. The training that a driver or passenger assistant requires may be dependent on the needs of the children who are travelling.

School staff receive training to allow them to manage a child's medical needs in school and, wherever possible, the transport staff that will be working with the child are expected to be able to participate in this training. As a minimum, training should include:

the handling of emergency situations, for example what to do in a medical emergency or if there is a road accident

equality, for example recognising, supporting and communicating with children with disabilities

any training required to meet the specific needs of the children travelling - for example, administering their emergency medication or managing their behaviour, and

it is recommended that training in the handling of emergency situations includes training in basic life support skills.

The guidance is clear that as well as ensuring drivers and passenger assistants receive any training they need to manage children's behaviour while travelling, your LA should not withdraw your child's transport arrangements due to behavioural challenges unless as a last resort. If your LA does withdraw arrangements for this reason, it will need to meet its transport duties in an alternative way (para 113).

If you haven't been able to find the answer to your question on this page, see the pages on the different categories of 'eligible children' linked above, or take a look at our FAQs.

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Children of compulsory school age (aged 5 to 16)

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LAs are required to arrange free, suitable, home to school transport for children of compulsory school age who are 'eligible', to their nearest suitable qualifying school

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Transport to school, for children up to the age of 16

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Transport to school, for children up to the age of 16

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This statutory guidance explains when local authorities have to provide transport to help children get to and from school. It includes details about what help should be provided for children with special educational needs or disabilities (see pages 11-15).

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People with learning disabilities can often have more difficulties with their physical and mental health, and may struggle to get the healthcare that they need.

Everyone over the age of 14 who has a learning disability should be on their GP's Learning Disability Register and be invited to a annual health check each year. Annual health checks help people with learning disabilities to have any health needs recognised early so they are more likely to get the support and treatment quickly when they need it.

Annual health checks can also help people with disabilities and their families to have a closer relationship with their local GP or Disability Nurse, and know who to go to when they have questions or concerns about their physical or mental health.

You can ask for your young person to be added to the Learning Disability Register at their local GP surgery so they will then be invited to a health check each year.

More information about annual health checks:

NHS England » Annual health checks

Learning disabilities - Annual health checks - NHS (www.nhs.uk)

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Harshi’s learning disability annual health check and health action plan

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Getting help for your young person's mental health difficulties

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Getting help for your young person's mental health difficulties

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Young people with learning disabilities can be more likely to struggle with mental health difficulties such as anxiety and depression. Sometimes these mental health symptoms and difficulties can be incorrectly attributed to their learning disabilities.

If you have any concerns about your child's mental health you can contact the Children and Adolescent Mental Health Service (CAMHS) using the links below. Wherever you live within Bedfordshire, young people or their families can now self-refer into their local CAMHS using this form:

Self-Referral form Bedfordshire CAMHS | East London NHS Foundation Trust (elft.nhs.uk)

Click the links below for more information about the help available for children living in Central Bedfordshire:

What we help with | East London NHS Foundation Trust (elft.nhs.uk)

South Bedfordshire/Luton CAMHS | East London NHS Foundation Trust (elft.nhs.uk)

North Bedfordshire CAMHS | East London NHS Foundation Trust (elft.nhs.uk)

The following guidance explains what mental health support should be available for people with disabilities:

Mental health problems | Information for the public | Mental health problems in people with learning disabilities: prevention, assessment and management | Guidance | NICE

mental-health-problems-in-people-with-learning-disabilities-what-care-you-should-expect-easy-read-version-2612226638 (nice.org.uk)

Recommendations | Mental health problems in people with learning disabilities: prevention, assessment and management | Guidance | NICE

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How to refer into Bedfordshire & Luton CAMHS

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Some young people with disabilities may find attending the dentist very challenging. Every local area provides dental clinics for children and adults with learning disabilities or mental health difficulties who struggle to access dental care at a normal dentist. Most of these special dental clinics will accept referrals from your regular dentist or from your GP.

Locations that offer specialist dental care:

Dental Care Centre, Bedford – Tel: 01234 310210
London Rd Dental Clinic, Bedford – Tel: 01234 310427
Liverpool Road Dental Clinic, Luton – Tel: 01582 708121
Leighton Buzzard Dental Clinic – Tel: 01525 751104
Houghton Regis Dental Clinic – 01582 512612
Queens Park Dental Clinic, Bedford – Tel: 01234 310859
Marsh Farm Dental Clinic, Luton – Tel: 01582 707435

You can ask your regular dentist, GP or other healthcare professional to refer your child to your local specialist dentist, or contact 03332 074002 cds.referrals@nhs.net

Bedfordshire - Clinics - Community Dental Services

Dental treatment for people with special needs - NHS (www.nhs.uk)

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Special care dental service   Megan's story

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Any young person under 19 can now apply for a 'YP Card' that entitles them to bus travel at the discounted rate of £1 per single fare. This applies on all days and at all times, and young people just need to show their card to the bus driver. They can still pay for their journey with cash or card as normal.

To qualify for the discounted fare, the journey must either start or finish within the county of Central Bedfordshire.

There are two cards available:

A green YP Card is issued up to a young person's 16th birthday, after which they receive an orange YP Card until they are 19. Both cards allow travel at the discounted rate of £1.

Click the image above to apply.

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Working in partnership with the government, we have launched a discounted bus travel scheme to help young people travel around the local area more cheaply. If you are a young Central Bedfordshire resident aged under 19 you can now apply for a YP Card. This will allow you to pay a maximum £1 single fare on any single bus journey within Central Bedfordshire and to some nearby towns and cities, as long as your journey is direct and starts or finishes in Central Bedfordshire.

The YP Card is available for all young residents of Central Bedfordshire aged 18 and under and can be used to make as many journeys as you like at the discounted £1 maximum single fare!

The YP Card may also entitle you to other travel discounts in the future.

There are two types of YP Card:

if you're under 16: a green YP Card, up to your 16th birthday

if you're 16 or over: an orange YP Card for up to your 19th birthday

Applying for your YP Card

To apply:

you must be aged 18 or under, and live in Central Bedfordshire

if you are under 16, you will need to ask a parent, guardian or carer to apply on your behalf

if you are aged between 16 and 19, you can apply yourself, although you are welcome to ask a parent, carer or guardian to apply on your behalf

you will need to provide proof of your date of birth, e.g. a birth certificate or passport. This should be scanned or photographed in JPG or PDF format, clearly showing your date of birth

you will need to provide your full postal address and a contact email address

you will also need a good quality digital photo/passport style image of yourself, ready to upload or capture. You can use the camera on your smartphone, tablet or PC to do this. Your photo should clearly show your whole face in front of a plain background with no-one else visible in the picture. Photos should ideally be in JPG format and must be no more than 5MB in size

Apply online now
Please note: when you submit your application, we will use address checking software to check that the address given is within Central Bedfordshire.

Please email public.transport@centralbedfordshire.gov.uk if you need help with your application, or if you cannot complete it online.

Once you have submitted your application, your YP Card will be sent to your home address within 10 working days. If your card has not arrived within this time, please let us know:
public.transport@centralbedfordshire.gov.uk.

If for any reason your application is unsuccessful, you will be notified via email. Should you wish to contact us about this, please email public.transport@centralbedfordshire.gov.uk.

If you apply for a Green YP Card within a month of your 16th birthday, your application will be rejected and you will be advised to apply for an Orange YP Card instead, which will be valid until your 19th birthday.

If you apply for an Orange YP Card within 2 weeks of your 19th birthday, your application will be rejected as our discounted travel scheme is only available up to your 19th birthday.

Please check your application very carefully and ensure that your photo and proof of age are clearly visible and are uploaded in the correct order. Please ensure all names and dates of birth match on both the application form and proof of age document. We cannot be held responsible for applications delayed due to mistakes being made on the submitted form. Due to the level of applications being received, it may take some considerable time for us to advise that your application has mistakes on it.

Using your YP Card

Your YP Card is valid 24/7, all year round, so can be used to travel to and from school or college, as well as at evenings and weekends.

Just show your YP Card to the driver when buying your ticket to qualify for the maximum £1 single fare. You will be able to pay your fare by cash, or by contactless card on many services. Your journey must start or finish in Central Bedfordshire to qualify for the discounted fare.

If you don't have your YP Card with you, you will be asked to pay the full fare.

What if your YP Card is lost, stolen or damaged?

Email public.transport@centralbedfordshire.gov.uk.

Replacement cards can be issued for a small administration fee of £5, but if your card has been stolen please report it to the police in the first instance. If you have a Crime Reference Number from the police, we can replace your card free of charge.

Our discounted travel scheme for young people is funded with part of the Bus Service Improvement Plan grant we have received from the Department for Transport (DfT).

The boring bits (terms and conditions)

Full terms and conditions for our YP Card and young person's discounted travel scheme can be found below:

Scheme title - Central Bedfordshire YP Card, hereafter referred to as 'the scheme'

Scheme brand - The scheme brand for all public communication is 'YP Card'

Description - The scheme enables eligible young people to purchase single bus fares at a discounted rate on presentation of a valid YP Card

Eligibility - eligible young people aged between 5 and 18, with a primary residence within Central Bedfordshire may apply. Green YP Cards will be valid until the day before the holder's 16th birthday. Orange YP Cards will be valid until the day before the holder's 19th birthday. If you are almost 16, you will be able to apply for your orange YP Card up to a month before your 16th birthday. If you are almost 19, we will not be able to process applications for Orange YP Cards within two weeks of your birthday

Geographical limits - The YP Card is valid on local bus journeys starting and/or finishing within Central Bedfordshire. You can also use your card to travel to or from the following destinations, providing your journey is direct and starts or finishes in Central Bedfordshire:

Aylesbury

Bedford Bus Station

Bletchley

Harpenden

Hemel Hempstead

Hitchin

Letchworth Garden City

Luton

Milton Keynes

St Albans

Stevenage

Times of operation - There are no restrictions on the time of day when the YP Card can be used

Types of journey - There are no restrictions on the types of journey for which the YP Card can be used. A YP Card will get you a discounted fare of £1 maximum single fare on most local buses for journeys starting or ending in Central Bedfordshire. However, it is not valid on long distance coach services, dedicated school buses where special school fares already apply or services provided by community transport operators

Ticket discount and restrictions - The YP Card will enable single bus tickets to be purchased for a maximum fare of £1. However, Central Bedfordshire Council may amend or withdraw the discounted travel scheme at any time

Transferability

The YP Card is for use solely by the individual named and pictured on the Card, and is not transferable

The YP Card will be withdrawn if used by anyone other than cardholder. Any misuse may result in criminal proceedings

YP Cards are issued subject to the conditions of the Scheme. The card remains the property of Central Bedfordshire Council

Application of discount on bus

The card holder is required to present their YP Card to the driver to obtain the relevant discount

Any passenger unable to present a valid card will be required to pay the full fare

The YP Card is not valid if altered or defaced in any way

YP Card holders are required to inform Central Bedfordshire Council immediately in the event a card is lost or stolen to enable a replacement card to be issued

Conditions of carriage - Each bus company's conditions of carriage will apply when travel is made with the card on their services

Scheme duration - Green YP Cards are valid until the day before the holder's 16th birthday. Orange YP Cards are valid until the day before the holder's 19th birthday. Central Bedfordshire Council may amend or withdraw the discounted travel scheme at any time

Card issue

Applicants are required to provide a recent passport sized colour photo

All information is provided in good faith by the applicant

Applications which are found to have been made using false information will not be issued with a card, or any existing card holders found to have acted fraudulently will result in the withdrawal of their card

Any breach of these conditions may render the applicant liable to prosecution

Replacement cards will be issued at a cost of £5 within 10 days of receipt of notification. Where a police crime number is provided in the case of stolen cards, a replacement card will be issued free of charge

Central Bedfordshire Council is not liable for any discount whilst an application or replacement is being processed

Cards remain the property of Central Bedfordshire Council and should be destroyed on expiry or termination of the scheme

Change of address - Card holders are required to inform Central Bedfordshire Council of any changes to their primary address. If the new address is outside Central Bedfordshire, the card will no longer be valid and must be surrendered.

Exclusions

The card is not valid on long distance coach services, dedicated school buses where special school fares already apply or services provided by community transport operators

The card does not provide proof of age

The card does not entitle or guarantee carriage on any bus service at any time, or give rise to expectation of the continuation of existing services or provision of new services

Central Bedfordshire Council will not be responsible for any losses or damage suffered when travel is made with the card

Central Bedfordshire Council reserves the right to amend terms and conditions from time to time and to withdraw or otherwise amend the discounted travel scheme

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Find out about the YP Card: our bus pass for young people.

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Disabled Facilities Grant for children and young people

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Disabled Facilities Grant for children and young people

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Some children and young people may need adaptations to their home to allow them to stay safe and be supported properly. A disabled facilities grant may be able to cover the cost of these adaptations. This grant is not means-tested if the young person is under the age of 19.

Adaptations may be needed because of a young person's physical or intellectual disabilities. If you feel you need adaptations to your home, you can apply for a Disabled Facilities Grant by contacting:

psh@centralbedfordshire.gov.uk or call 0300 300 8050

Disabled Facilities Grant | Central Bedfordshire Council

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Applying for a Disabled Facilities Grant (DFG) | Central Bedfordshire Council

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Applying for Transport to Post-16 Education or Training

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Applying for Transport to Post-16 Education or Training

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The local authority can offer subsidised transport assistance to the nearest post-16 school or college that can meet the young person's needs and that offers their preferred course of study. This is usually offered where the school or college is more than 3 miles away from a young person's home. However, if your young person's needs mean that they are unable to walk 3 miles safely, they should still be eligible for transport assistance.

Transport assistance is only subsidised, and a termly fee is usually charged unless your family is on a low income. If your young person chooses to attend a mainstream school or college that is not the nearest one offering the course they want, they will not be eligible for this transport assistance.

The programme of study must normally be full-time, which is defined as 15 hours per week for at least 30 weeks of the year. However, if your young person is attending post-16 education part-time because of their SEND, they will still qualify.

Post-16 transport should be applied for each year by 15th July to ensure that travel arrangement are in place ready for the start of term in September. Applications can be made after this date, but it may take longer to have the transport in place.

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Apply for school transport | Central Bedfordshire Council

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Make an application for school transport online. Apply today for school transport

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This statutory guidance explains what transport assistance local authorities have to provide to help young people get to and from their post-16 education. It includes details about what support should be provided for young people with special educational needs or disabilities (see pages 13-14).

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When a young person moves into post-16 education (after year 11) they can apply for a Vulnerable Learner Bursary to help with the cost of of things such as transport, books or equipment for their course of study.

To be eligible for this bursary young people must be aged 16-19 when they start their course and this must be at a publicly funded school or college, or at a training course (including unpaid work experience). In order to apply a young person also needs to be in receipt of Disability Living Allowance (DLA), Personal Independence Payment (PIP), Employment and Support Allowance (ESA) or Universal Credit (in their own name). The Bursary can be worth up to £1,200 but the amount will depend on the young person's particular needs and the course they have chosen.

You or your young person can apply for this bursary through their post-16 school, college or training provider.

Please see the links below for further help:

16 to 19 Bursary Fund: Eligibility - GOV.UK (www.gov.uk)

Financial Support | The Bedford College Group | Bursary

Learner Support Fund | Barnfield College

Financial support - North Hertfordshire College (nhc.ac.uk)

Financial Support - Cambridge Regional College (camre.ac.uk)

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GOV.UK uses cookies to make the site simpler.

You could get a bursary to help with education-related costs if you're aged 16 to 19 and:

studying at a publicly funded school or college in England - not a university

on a training course, including unpaid work experience

A publicly funded school is one that does not charge you for attending it.

If you're 19 and over

You could also get a bursary if you either:

What a bursary is for

A bursary is money that you, or your education or training provider, can use to pay for things like:

clothing, books and other equipment for your course

transport and lunch on days you study or train

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GOV.UK uses cookies to make the site simpler. You could get a bursary to help with education-related costs if you're aged 16 to 19 and: studying at a publicly funded school or college in England - not a university on a training course, including unpaid work experience A publicly funded school is one that does not charge you for attending it.

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Supported Internships help young people aged from 16 who have additional needs or disabilities prepare for paid employment.

Internships are a combination of workplace volunteering and study at college, to help prepare young people to move into a paid job. They are usually offered by colleges and other specialist providers who connect with local employers that can offer six month work placements.

Find out about supported internships within and near Bedfordshire using the links below:

Supported Internships | Central Bedfordshire SEND Local Offer

Bedford College:

Supported Internship (Pathways) – 21303 23 | The Bedford College Group

Barnfield College:

Supported Internship - (Progressing Students Only) | Barnfield College

North Herts College:

EXTERNAL SUPPORTED INTERNSHIP - North Hertfordshire College (nhc.ac.uk)

You can also get help from the Young Adult and Independent Living Team (YAaIL):

Young Adult and Independent Living Team (YAaIL) | Central Bedfordshire SEND Local Offer

More information about supported internships can be found here:

Supported internships - GOV.UK (www.gov.uk)

Supported Internships For 16-24 Year-Olds | UCAS Progress

What is Internships Work? - NDTi

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Supported internships for people with additional needs

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Help with finding and keeping a job: Supported Employment Service

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Help with finding and keeping a job: Supported Employment Service

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Central Bedfordshire also offers a supported employment service for young people with a learning disability. This service can support them to find and apply for work, attend job interviews, helping them manage paid work with their benefits, and help them develop in their working role.

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This is a specialist supported employment service for young people and adults with a learning disability. We support people to get paid employment, access work trials and find out about volunteering placements.

We aim to:

increase the numbers of people with learning disabilities in paid employment

support people in a wide range of employment settings

raise awareness among employers of the employment needs of people with learning disabilities and the positive contributions they can make to the workplace

create the right opportunities for personal development and career progression.

We can:

help you to identify what kind of paid job you are interested in - we call this 'vocational profiling'

help you to find the right employer and the right job - we call this 'job searching'

help you with applications and interviews and identify support for you in the workplace - we call this 'job coaching'

support you to retain (this means 'keep hold of') your paid job and help you to develop in your role - we call this 'job retention and career development'

help you to understand the relationship between paid work and any benefits you may be receiving

Working together

We work together with you and look for:

support from your family and friends, if appropriate

work with any other professionals or support staff you may be linked with to help achieve the outcome of a paid job - we call this working 'co-productively' - it means working together

Referral to the service for young people and adults with a learning disability

Contact us to find out more.

Telephone: 0300 300 8100

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Learning disabilities | Central Bedfordshire Council

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A learning disability can affect the way a person learns new things in a range of different life areas. It can affect the way a person understands information and how they communicate

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Access to Work: financial support to help people with disabilities to get and stay in work

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Access to Work: financial support to help people with disabilities to get and stay in work

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An Access to Work grant can help to pay for the support that people with disabilities need to get a job or to stay in work. Young people must be at least age 16 to be eligible and must already be in work or about to start a new job. This work can be full or part-time, it can be an apprenticeship or an internship, work experience, or self-employment. But it must be paid work. Getting the grant is not affected by a person's other income and can be claimed at the same time as most benefits.

Find more information and how to apply here:

Access to Work: get support if you have a disability or health condition: What Access to Work is - GOV.UK (www.gov.uk)

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Moving from Disability Living Allowance (DLA) to Personal Independence Payment (PIP)

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Moving from Disability Living Allowance (DLA) to Personal Independence Payment (PIP)

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When your young person reaches age 16, they may need to move from DLA to PIP. When you need to apply for PIP for your young person, you will receive a letter from the Department of Work and Pensions (DWP) asking you to make a claim and explaining how you can do this. Payment of DLA will continue until PIP is in place, but you will need to apply by the date given in the letter.

If your young person has never claimed DLA, they are still entitled to apply for PIP from age 16. You can find out who is eligible, how much you might receive, and how to claim here: https://www.gov.uk/pip

More help with applying for PIP can be found here:

Personal Independence Payment (PIP): What PIP is for - GOV.UK (www.gov.uk)

Personal Independence Payment (PIP) | Mencap

SMN - Guide to completing a Personal Independence Payments (PIP) form (youtube.com)

Moving from DLA to PIP - Citizens Advice

Changing from DLA to PIP | Disability charity Scope UK

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Disability Living Allowance (DLA) for children – When a child turns 16

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Filling in the PIP claim form can feel overwhelming. Please use the links below for help and support about how to do this:

Check how to fill in your claim form - Citizens Advice

This video explains what PIP points are and how many are needed to receive the standard or enhanced rate of PIP:

The Three Minute Guide to PIP points (youtube.com)

Click this link to see the points awarded for different types of difficulties in each of the activity sections on the form:

pip-9-table-of-activities-descriptors-and-points.pdf (citizensadvice.org.uk)

The governments full guidance on how PIP should be assessed and awarded can be found here:

PIP assessment guide part 2: the assessment criteria - GOV.UK (www.gov.uk)

PIP handbook - GOV.UK (www.gov.uk)

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Applying for PIP - how to fill in your claim form

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If your child will continue to need help to manage their benefits after the age of 16, you will need to register as their DWP Appointee.

Click this link to find out who you need to contact to become a DWP Appointee for your child:

Become an appointee for someone claiming benefits - GOV.UK (www.gov.uk)

More information about becoming a DWP Appointee:

Becoming an appointee | Disability charity Scope UK

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When a young person reaches the age of 16, by law they are then entitled to begin making some decisions for themselves independently of their parents or carers. This might include decisions such as consenting to medical treatment, deciding where they will live, claiming benefits in their own name or making financial decisions.

However, where a young person is not able to make some or all decisions for themselves because of their additional needs or disabilities, the Mental Capacity Act (MCA) allows others to make these decisions for them. The MCA requires that every possible support must be offered to the young person first to allow them to make a decision for themselves, but where this is not possible others are then able to make the decision on their behalf and in their best interests.

Until a child reaches age 18, parents still have legal rights and responsibilities for their child which is called 'parental responsibility'. Having parental responsibility means that parents and carers can still make many decisions for their child until they turn 18, although a clear definition of exactly which decisions fall within 'parental responsibility' is still not clearly described within the law.

After the age of 18, any decisions that are made for the young adult should be made in their best interest by everyone involved in their care. This must include their family members who should be fully involved in any decisions that are made.

Once a young person has turned 18, family members can apply to the Court of Protection for Deputyship, to be granted the legal right to act on behalf of their young adult and make decisions for them. Please see later sections of this guide for more information about Deputyship.

Find more information about the Mental Capacity Act and parental responsibility here:

Parental responsibility & mental capacity beyond 16 | Contact

Mental Capacity Act - Social care and support guide - NHS (www.nhs.uk)

What is The Mental Capacity Act? | Mencap

Parental rights and responsibilities: What is parental responsibility? - GOV.UK (www.gov.uk)

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The video explains more about the Mental Capacity Act (MCA) and the rules around how decisions can be made for someone who can not make them for themselves.

What is the Mental Capacity Act? - Mind

Mental Capacity Act 2005 (legislation.gov.uk)

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The Mental Capacity Act: an animated guide by Infodeo.

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Will my young person lose their EHCP at 18?

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Will my young person lose their EHCP at 18?

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Whilst most young people leave further education at age 18, some young people with SEND need to stay in education for longer to consolidate their learning in preparation for adulthood. If this is the case, your young person's EHC Plan can continue until age 25 as long as they still have special educational needs and they are still in some form of education or training (excluding higher education e.g. university).

The local authority can only take away a young person's EHC Plan if any of the following apply:

The young person's special educational needs have changed and no longer require the provision set out in the plan. However, if the outcomes in the EHCP have not been met then the EHCP should continue and the provision amended

The local authority is no longer responsible for the young person because they have moved to a different local authority area

The young person is no longer attending any kind of education

The young person has moved into higher education e.g. university

The young person has reached age 25

The young person is in paid employment

The local authority can also cease an EHCP if the young person no longer needs the provision set out within it. However, the law requires the local authority to consider whether the outcomes in the EHCP have been achieved. If they have, there may still be a need to set new outcomes for the young person. If not, then this would indicate that the EHCP should continue.

Find out what to do if your young person's EHCP is being ceased by the local authority:

If your LA takes away your EHC plan | (IPSEA) Independent Provider of Special Education Advice

Changes in circumstances | Contact

The SEND Code of Practice p202-205 explains when an EHCP can be ceased:

SEND_Code_of_Practice_January_2015.pdf (publishing.service.gov.uk)

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SEN Legal Webinars - Ceasing to Maintain an EHC Plan

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This guidance explains the entitlement to an EHCP for those aged from 19-25 years.

The SEND Code of Practice p202-205 is statutory guidance that explains when an EHCP can and cannot be ceased:

SEND_Code_of_Practice_January_2015.pdf (publishing.service.gov.uk)

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This non-statutory guidance is primarily for local authorities. It aims to support them in making fair and consistent decisions about when they should maintain an EHC plan beyond the age of 19, or issue an EHC plan to a young person aged 19 or over, in line with their duties under the Children and Families Act 2014, and as described in the SEND Code of Practice.

1. Managing 19- to 25-year-olds' EHC plans

Reforms to the SEND system (see the SEND code of practice) should mean that children and young people are better prepared for adulthood. The majority of young people with EHC plans complete further education with their peers by age 19, and our expectation is that this will continue. However, we recognise that some young people with SEND need longer to complete and consolidate their education and training. The length of time will vary according to each young person, and judgements on when to stop or maintain a plan must be made on a case-by-case basis and in accordance with the statutory tests and processes (see section 45 of the Children and Families Act 2014 and paragraphs 9.199 - 9.210 of the SEND Code of Practice).

It is important that young people start to think about their aspirations as early as possible. It is critical that, from year 9 at the latest, local authorities help young people (and their parents and carers) to start planning for a successful transition to adulthood. This includes setting stretching and ambitious outcomes. This should follow consideration of any further education or training that will enable young people to secure paid work, or other opportunities for a positive adult life.

Young people should be supported to exercise choice and control over their lives, including the 4 'preparing for adulthood' outcomes:

moving into paid employment and higher education

independent living

having friends and relationships and being part of their communities

being as healthy as possible

More information on the 4 'preparing for adulthood' outcomes can be found in chapter 8 of the SEND Code of Practice.

In line with preparing young people for adulthood, a local authority must not cease an EHC plan simply because a young person is aged 19 or over. Young people with EHC plans may need longer in education or training to achieve their outcomes and make an effective transition into adulthood. However, this position does not mean that there is an automatic entitlement to continued support at age 19 or an expectation that those with an EHC plan should all remain in education until age 25. A local authority may cease a plan for a 19- to 25-year-old if it decides that it is no longer necessary for the EHC plan to be maintained.

1.1 Maintaining existing EHC plans

When a 19- to 25-year-old continues with an EHC plan, the local authority must review it at least annually. The plan must contain outcomes which should enable the young person to complete their education and training successfully and move on to the next stage of their lives (see paragraph 9.64 of the Code). This will happen at different stages for individual young people and EHC plans extended beyond age 19 will not all need to remain in place until age 25.

For young people with more complex needs who are likely to continue to need specialist support in adult life, services will need to work together at a local level to plan and fund a smooth transition. These include:

children's services

adult social care

housing and health

This strategic planning, aided by joint commissioning and integrated services, will support a young person to:

transition successfully to adult life

receive the right support from adult services where needed

1.2 Assessing new applicants

Section 36 of the Children and Families Act sets out that all young people aged 19 to 25 have the right to request an EHC needs assessment unless one has been carried out in the last six months (see paragraphs 9.11 - 9.19 of the Code, giving further detail about the processes to follow when a request for assessment has been made).

The local authority must decide whether to proceed with the assessment within six weeks. It must assess in circumstances where:

the young person has or may have special educational needs, and

it may be necessary for special educational provision to be made for the young person in accordance with an EHC plan.

Where the local authority judges that an assessment is not necessary, the young person has the right to appeal to the First-tier Tribunal (Special Educational Needs and Disability) about this decision. More information on resolving disagreements can be found in chapter 11 of the SEND Code of Practice.

After a young person has been assessed, the local authority has to decide whether an EHC plan is necessary by following:

The local authority must also consider whether the young person requires more time, in comparison to others of the same age who don't have SEND, to complete his or her education or training.

The outcomes specified in an EHC plan for a 19- to 25-year-old should be focused on meeting their aspirations and preparing them for adulthood.

More information and examples of outcomes can be found in:

Section 45 of the Children and Families Act sets out the circumstances when a local authority may cease to maintain an EHC plan. This is when the local authority is no longer responsible for the young person, or they decide that it's no longer necessary to maintain the plan (for example if special educational provision is no longer necessary). When determining whether a young person aged over 18 no longer requires a plan, a local authority must consider whether the educational or training outcomes specified in the plan have been achieved.

When a young person is close to finishing their education and training, the local authority should use the final annual review to agree the support needed to help them engage with services after they leave education.

Where a young person aged 18 or over leaves education or training before the end of their course, the local authority must not end the EHC plan without a review. The review should determine whether the young person wishes to return to education or training, either at the educational institution specified in the EHC plan or somewhere else.

If the young person does wish to return to education or training and the local authority decides that it's appropriate, then they must amend the EHC plan as necessary and maintain the plan. The local authority should seek to re-engage the young person in education or training as soon as possible.

2. Education, training and benefits

It's crucial that local authority 'local offers' clearly set out what is normally available for 19- to 25-year-olds with special education needs and disability ( SEND), to ensure educational and training needs are met, regardless of whether they have an EHC plan.

Students aged 19 to 25 with EHC plans who are continuing in education may have a range of options, including attending:

further education

training

a supported internship

an apprenticeship

For more information on study programmes, see:

Local authorities should consider the need to provide young people with EHC plans with a full package of support across education, health and care 5 days a week, if appropriate. Packages could involve amounts of time at different providers and in different settings and may include periods outside education institutions with appropriate support.

The package, which does not need to include study towards formal qualifications, can include activities such as:

volunteering or community participation

work experience

independent travel training

skills for living in semi-supported or independent accommodation

training to develop and maintain friendships

access to local facilities

physiotherapy

Local authorities will need to work with providers and young people to ensure there is a range of opportunities that can be tailored to individual needs, including the use of personal budgets.

A young person's progress whilst they have an EHC plan can be recognised in a variety of ways, including when they do not undertake formal qualifications. This includes ('Recognising and Recording Progress and Achievement') - a 5-stage process to measure the progress and achievement of learners on non-accredited learning programmes. It may also be helpful to track progress with this recently published Preparing for Adulthood outcomes tool, designed to support the development of preparation for adulthood outcomes in EHC plans across the age range, although there are other ways to measure progress.

2.1 Special schools

Young people aged 19 can't remain in a special school unless they're completing a secondary education course started before they were 18 years old. Special schools have the option of setting up a legally and financially separate entity to provide education for 19- to 25-year-olds, as advised in the ' High needs funding: operational guide 2016 to 2017' ('Learners aged 19 to 25 with an EHC plan').

2.2 Supported internships

As stated in the ' Post-16 skills plan', we want all young people with an EHC plan to undertake a supported internship unless there is a good reason for them not to.

Supported internships are one of the most effective routes to employment for young people with EHC plans. They are a structured study programme, based primarily at an employer. They help young people get paid jobs by giving them the skills they need for work.

Supported internships are unpaid, and last for a minimum of 6 months. Where possible, young people will move into paid employment at the end of the programme. Alongside their time at the employer, young people complete a personalised study programme and are supported by an expert job coach where needed.

2.3 Providing education in a non-education setting

Education for the majority of those aged over 16 should be through a study programme, including those with EHC plans (see paragraph 7.6 of the SEND Code of Practice).

However, there may be times when special educational provision can be provided outside an institution funded by the Education and Skills Funding Agency ( ESFA), such as in a residential care home or other non-educational setting. In these cases, it would be appropriate for the education service to fund this. Decisions are made on an individual basis and currently, these cases are rare.

2.4 Studying in a higher education institution (HEI)

The ESFA funds some courses in higher education institutions ( HEI) that are not prescribed higher education courses, meaning it's possible to have an EHC plan in these circumstances.

HEIs can use their ESFA allocation to provide support for particular students, provided it meets the funding, study programme and eligibility criteria that ESFA publish every year for 16 to 19 students (see ' 16 to 19 education: funding guidance'). Prospective students should be made aware that HEI providers are not legally bound by the Children and Families Act 2014. However, they are legally bound by the Equality Act 2010.

2.5 Studying a level 4 (higher education level) qualification

Studying at this level would be considered a positive outcome from an EHC plan, and a pathway to finding a good job. However, a young person studying at level 4 in an FE college would not be entitled to an EHC plan.

There are separate systems in place to support disabled young people in higher education ( HE), including Disabled Students' Allowances (DSAs). These are non-repayable grants that assist with the additional costs incurred by disabled students. They apply to those studying HE in an FE environment. DSAs fund a range of support, including assistance with the cost of:

specialist equipment

travel

non-medical helpers (for example sign language interpreters)

For more information see the DSA finance guide.

2.6 Supporting young people who have not found a job

19- to 25-year-olds who make a benefit claim will be invited to meet a work coach at the Jobcentre. For those claiming Job Seekers' Allowance ( JSA), this will be as soon as possible. For those claiming Employment Support Allowance ( ESA) and presenting a fit note, this will be within 4 to 6 weeks of their claim. At the Jobcentre, the work coach will discuss the young person's needs and any barriers to work. They'll then agree a plan of action (a 'claimants' commitment') detailing their plans to find work.

The Department for Work and Pensions ( DWP) offers specialist employment programmes to support people into work. These include the Work Programme, Work Choice and the Specialist Employment Service. Work coaches will also signpost claimants to other local options. An Access to Work grant provides support to those with a disability or health condition who need help to work. Those with a longer term disability or health condition will have a Work Capability Assessment.

What is funded from the local authority's high needs budget would depend on the outcomes and needs specified in the young person's EHC plan. The local authority is responsible for putting the plan together and working with the Clinical Commissioning Group (CCG) and other partners to secure appropriate provision.

The local authority's high needs budget is expected to provide the institution with top-up funding for any special education described in Section F of the EHC plan, to cover the costs of additional support in excess of £6,000 per annum. A local authority can jointly fund some education with its partners and may decide to add health or care funding to the education funding from its high needs budget, to provide a full package of support for an individual.

The ESFA allocates place funding of £6,000 per annum directly to FE institutions for high needs places required by the commissioning local authorities for students with high needs, aged 19 to 25 with an EHC plan. The local authority's high needs budget cannot be used for 19- to 25-year-olds who do not have an EHC plan, unless they are completing a course started before they were 18 years old.

3.1 Funding for those with no EHC plan

Eligibility to receive public funding through the Education and Skills Funding Agency is the same for all eligible learners regardless of disability.

For students aged 19 and above who don't have an EHC plan, learner support funding may be available to help them meet:

the additional needs of learners with learning difficulties and/or disabilities

the costs of reasonable adjustments as set out in the Equality Act 2010

This support can cover a range of needs including:

funding to pay for specialist equipment and helpers

arranging note takers

particular help in lectures and seminars

special arrangements for exams

In all instances learners should contact their provider to confirm they're eligible for funding, and to check that the qualification or course they wish to study is funded by the ESFA.

For students aged 19 to 25 without EHC plans, further education ( FE) providers receive money from the ESFA to meet the costs of reasonable adjustments. Under the Equality Act 2010, FE providers must make reasonable adjustments to avoid disabled students being placed at a 'substantial disadvantage'.

All aspects of studying are covered including:

course admissions

the provision of education

access to any benefit, facility or service, for example flexible courses

exclusions

Private education and training providers also have duties under part 3 of the Children and Families Act as service providers.

4. Considering health and social care needs

Decisions about whether a young person's EHC plan should be maintained after age 19 will depend on whether they'll need special educational provision to meet the outcomes set out in their EHC plan. If a young person has achieved the outcomes in their EHC plan by age 19, then no further special educational provision should be required after that age.

If a young person over the age of 18 continues to have an EHC plan, they may have social care and health needs. Each local authority's local offer must set out:

the relationship between the Children and Families Act 2014 and the Care Act 2014

how the requirements of both acts are being implemented locally

It's critically important that CCGs and health providers work closely with local authorities to provide a coordinated and coherent offer to young people with social care and health needs after the age of 19.

The Care Act 2014 places a duty on local authorities to conduct transition assessments for children or young people, their carers and young carers where there is a likely need for care and support after the young person turns 18.

4.1 Social care

Where young people aged 18 or over continue to have EHC plans, and are receiving care and support, this will be provided under the Care Act 2014.

The EHC plan should be the overarching plan that ensures young people receive the support they need to help them achieve agreed educational outcomes. The statutory adult care and support plan (see part 3 of the Children and Families Act) should form the 'care' element of the young person's EHC plan.

CCGs should use the ' National framework for NHS continuing healthcare ' to determine what ongoing care services young people should receive.

It's important that representatives from adult NHS continuing healthcare:

Health and social care colleagues may also find it useful to look at the NICE guidelines on transitioning from children's to adult's services for young people using health or social care services.

In addition to this, many young people with chronic health conditions will require ongoing care from their local GP surgeries.

5. Including young people in decision-making

Local authorities should be aware that from the age of 16 a young person is responsible for making decisions. We should not assume that parents will make decisions on behalf of young people over 19 with an EHC plan, even if there are questions over the young person's mental capacity.

The Children and Families Act 2014 states that local authorities must:

understand the importance of young people participating 'as fully as possible' in decision-making

provide information and support to assist their participation in decision-making

It also identifies specific decision-making rights about 19- to 25-year-olds' rights relating to EHC plans. For example, they have the right to:

request an assessment (any time up to their 25th birthday)

make comments about or request changes to the content of the plan

request that a particular institution is named in their plan

request a Personal Budget for elements of their plan

appeal to the First-tier Tribunal (Special Educational Needs and Disability) about decisions

The Council for Disabled Children has developed a toolkit to help young people make their own decisions. Find out more about the Mental Capacity Act in the code of practice and 'Preparing for Adulthood' factsheet.

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SEND: 19- to 25-year-olds' entitlement to EHC plans

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This non-statutory guidance is primarily for local authorities. It aims to support them in making fair and consistent decisions about when they should maintain an EHC plan beyond the age of 19, or issue an EHC plan to a young person aged 19 or over, in line with their duties under the Children and Families Act 2014, and as described in the SEND Code of Practice.

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Universal Credit is a benefit that your young person may be eligible for as an adult, if they are not able to work or they are on a low income. Universal Credit is gradually replacing other disability benefits such as Employment and Support Allowance (ESA), Income Support and Housing Benefit.

Universal Credit is paid monthly and can include money for housing costs as well as money for living expenses. Adults with long-term health conditions or disabilities who are unable to work can be eligible for extra amounts. If your young person needs to move onto Universal Credit from other benefits, they will receive a letter from the DWP telling them how to do this and when to apply.

Universal Credit is separate from Disability Living Allowance (DLA) and Personal Independence Payment (PIP), so these benefits will not affect the application for Universal Credit or how much they will receive.

For more information check out these links:

https://www.gov.uk/universal-credit

Moving to Universal Credit from other benefits - Citizens Advice

Getting Universal Credit if you’re sick or disabled - Citizens Advice

Applying for Universal Credit | Disability charity Scope UK

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UC, short for Universal Credit, is the name of a benefit that some people who do not work, do not work many hours, or who do not earn much money can get.

The money is to help to pay for your living costs.

Living costs include things like Rentis the money that you pay to live in your home when you have a tenancy agreement landlord A landlord is the owner of a property which they rent out to tenants. They can be a council A council is also called a local authority A local authority is also called a council. They are a group of people who make decisions about some of the things in the area where you live like schools, social care rent A Tenancy agreement is where the person renting a house, and the person who owns the house, agree on things like how much rent to pay, who will mend things like the cooker if they go wrong, and whether you are allowed pets. . Your home belongs to a Social care means the services that give care and support to people who need it. (support for people), parks and dustbin collection. . They are a group of people who make decisions about some of the things in the area where you live. These include: schools, social care (support for people), parks and dustbin collection. , a housing association, or an individual person. , but you have a right to live there as long as you followthe rules that are in your tenancy agreement. , food and energy bills.

It's easy to apply for Universal Credit.

If you are receiving any of the benefits or tax credits that Universal Credit is replacing, you do not need to apply for Universal Credit unless:

your circumstances change, or

you need to make a new claim for benefits (for example you need to start to claim help with housing costs), or

you get a letter called a 'Migration Notice' telling you that you must claim Universal Credit

If you live with your partner, you will both need to apply for Universal Credit.

To find out how to apply for Universal Credit, we have created a straightforward step-by-step digital guide to take you through the application process.
Find out more →

Universal Credit is usually paid every month into your bank or building society account. The date that you get your first payment will be the date that you are paid every month (unless it is a weekend).

Your payment might include money for your rent or other housing costs which you will need to pay to your landlord.

If you find it difficult to manage your money with a monthly payment, you can ask for your Universal Credit to be paid more often, for example twice a month, or 4 times a month. You can also ask for your rent or housing costs to be paid direct to your landlord.

If you need money while you are waiting for your first Universal Credit payment, you can ask for an advance payment. If you get an advance payment, the money will be taken off your Universal Credit payments.

You might have money taken off your Universal Credit payment if you have a paid job, or you get money from some other benefits or a pension.

For more information about when you will get money taken off your payment visit the government's information about Universal Credit payments

Can I claim Universal Credit?

To get Universal Credit you must:

be 18 or over (you can sometimes get Universal Credit if you are 16 or 17)

be under State Pension age

live in the UK

have £16,000 or less in money, savings and investments. The £16,000 threshold applies to single claimants as well as couples.

The full eligibility criteria for Universal Credit can be found on the UK government website.

Can I claim Universal Credit if I have a disability or health condition and am not able to work?

When you apply for Universal Credit, you can let the DWP know if you have a disability or health condition that affects how much you can work. You will need to provide a fit note (also known as a 'sick note') and complete a 'Capability for Work' (UC50) health questionnaire.

You will be told if you need a Work Capability Assessment An assessment is a way of finding out what help a person needs. When you have an assessment, you might have to go to a meeting or fill in a form. (link to our WCA page). The Work Capability Assessment will decide if you are able to work, or need to prepare to work in the future. It will also decide if you will be paid extra Universal Credit because of your disability or health condition.

Will I be paid my housing costs?

If you are eligible for Universal Credit, you can claim for help with your housing costs. This is called a housing payment. Your housing payment can help you pay your:

rent to a private landlord

rent and service charges if you rent from a housing association or local authority, for example council housing

service charges if you or your partner own the property you live in

If you live in supported or sheltered housing, you can apply for Universal Credit to help with housing costs if you're not getting 'care, support or supervision' through your housing.

Can I have 2 weekly payments?

If you find it difficult to manage your money with a monthly payment, you can ask for your Universal Credit to be paid more often, for example twice a month. You can do this by asking for an Alternative Payment Arrangment.

You can ask for an Alternative Payment Arrangement:

in your online Universal Credit account

during a meeting or conversation with your work coach or case manager A manager is a boss at work. They tell you what you need to do and give you support if you need it.

by phoning the Universal Credit helpline on 0800 328 5644

Do I have to attend appointments?

After you have applied for Universal Credit, you will usually need to go to a meeting at your local jobcentre to talk about your 'claimant commitment'. Your claimant commitment is what you agree to do so that you can be paid Universal Credit.

If you find it difficult to go to a meeting at the jobcentre because of your health condition or disability, you can change where you have the meeting. You might be able to have the meeting at a place that is easier for you to get to, or by phone.

Do I have to move from Employment Support Allowance (ESA) to Universal Credit?

Universal Credit is replacing income-related Employment and Support Allowance (ESA). If you get ESA, you do not need to do anything unless:

your circumstances change, or

you need to make a new claim for benefits (for example you need to start to claim help with housing costs), or

you get a letter called a 'Migration Notice' telling you that you must claim Universal Credit.

The information on this page is for guidance Guidance means being given clear instructions to be able to do something well. only. Mencap hold no responsibility for DWP processes, timescales, decisions andservice.
As well as the DWP you can also contact the Learning Disability Helpline about any general welfare benefit queries.

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Find out if you're entitled to Universal Credit, how to apply and how to challenge decisions.

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Benefits calculator - what are you entitled to?

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Benefits calculator - what are you entitled to?

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Use this benefits calculator to see what benefits your young person might be entitled to as an adult.

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Use the Turn2us Benefits Calculator to find out which welfare benefits you may be entitled to.

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VoiceAbility is a charity that can support young adults to get the voices heard as part of their Care Needs Assessment or when they are hospital. They can also support young adults to challenge any decisions made about them or to make a complaint. This is called 'advocacy'

VoiceAbility | Bedford Borough and Central Bedfordshire

Your or your young person can request advocacy help here:

VoiceAbility | Make a referral

Recommendations | Advocacy services for adults with health and social care needs | Guidance | NICE

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VoiceAbility: what we do and why we do it (with subtitles and BSL)

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Providing for your child in the future - Wills & Trusts

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Providing for your child in the future - Wills & Trusts

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Providing for your young person in your will needs careful consideration. A Disabled Trust can help protect the money that you may leave for them. Watch this video to find out more and contact a legal professional for more advice about what your best options are for your particular circumstances.

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How to protect your disabled child's inheritance with a Disabled Person's Trust in your Will

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What's the difference between social care and health care? and who pays?

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What's the difference between social care and health care? and who pays?

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The difference between social care and health care and who pays

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NHS continuing healthcare (CIC) is care and support that is arranged and funded by the NHS only, and not by the local authority. It can fund care in any setting including care at home or in a residential care home. A person is usually eligibility for this kind of funding for their care if their support needs are primarily due to a health condition or illness. However, severe behavioural difficulties can also contribute to someone's eligibility for this funding, as can severe communication and cognitive difficulties.

The NHS in the UK is a free service to everyone, so if the care and support that a person needs is eligible for 100% CIC funding, they will not need to make any contribution towards the cost of their care regardless of their financial circumstances.

In reality most young people with care and support needs will have this care paid for by their local authority as adult social care. As a result, they will have a financial assessment on their income and be expected to make a contribution to the cost of their care. Some young people with more severe intellectual or behaviour difficulties can sometimes be part-funded by both NHS CIC and the local authority. In this instance they would still have a financial assessment and make the same contribution, as this would help fund the proportion of the care paid for by the local authority.

The NHS uses a Decision Support Tool (DST) to decide if someone is eligible for CIC funding for their care. This tool can be found here: NHS continuing healthcare decision support tool guidance - GOV.UK (www.gov.uk)

There are 12 different areas or 'domains' against which a person's condition is measured on a scale that goes from 'no need' to 'priority need'. Generally, in order to be eligible for some level of CIC funding a person must have at least one 'priority' need or two 'severe' needs across these domains; although it is possible to qualify with a 'severe' need in one domain and 'high' needs in others.

If Adult Social Care at the local authority believes that your young person may qualify for NHS CIC funding, they can arrange an assessment for them.

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NHS Continuing Healthcare: A Step by Step Guide to the NHS CHC Assessment

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Learning Disability Intensive Support Team in Bedfordshire

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Learning Disability Intensive Support Team in Bedfordshire

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The Intensive Support Team (IST) can help support adults with learning disabilities who struggle with severe mental health difficulties or behaviours that challenge. They are a team of doctors, nurses and therapists who come together to provide intensive assessment and treatment to enable adults to continue to live successfully within their community.

The team can help young adults who still live at home with family, or who live independently in the community. They can be contacted on: 01234 310538 nelft.ist@nhs.net

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learning disabilities intensive support team bedfordshire

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Learning Disabilities Intensive Support Team - Bedfordshire | East London NHS Foundation Trust

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We provide a 24-hour crisis service as well as community-based services to people who have a learning disability and are 18 years+, living within Bedfordshire & Luton.

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These sections will tell you about the law and statutory guidance that local authorities, the NHS, schools/colleges and other organisations must follow when supporting young people and adults with disabilities. It will explain what the law says about supporting people with their education or work, their daily-living needs, and accessing NHS/health services.

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Bank accounts for children and teenagers

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Bank accounts for children and teenagers

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Supporting your child to open a bank account can be easier when they are legally still a child and under the age of 16.

Before a child reaches 16, parents and carers are usually able to apply online for their child and can help manage the account on their behalf without needing any additional legal status to be able to do so. Many banks will automatically change a child account into an adult account when the child reaches 18.

Once your child has turned 18 (and 16 in some cases) they are legally an adult and so will need to be able to communicate with the bank themselves to be able to open their own account. Opening a bank account on their behalf can usually only be done if you have a financial Deputyship in place for them (more about that later in this guide).

Having their own bank account will allow your young person to receive their own income or benefits in their own name when they become adults, and can help them to begin learning how to manage their own money, use their own debit card or use a cash machine.

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If you are keen for your kids to get used to managing money, you should encourage them to open their own bank account.

Most providers offer bank accounts to children between the ages of 11 and 18.

They are generally similar to adult ones; you can pay money in and make withdrawals from an ATM or in a branch.

The main difference is that children's bank accounts don't offer overdrafts.

So, there's no way your child can accidentally or intentionally spend more than is in the account and be hit with fees.

You'll also find these accounts may offer the choice between a cash card that allows ATM withdrawals or a debit card, which can be used in shops, online and at ATMs.

Most banks will let you control which card your child gets.

You should bear in mind you will usually have to accompany your child to open a bank account in a branch or do it on their behalf if they are under 16.

Some banks let you fill in an application form online, but you'll probably still have to go into a branch to complete the application and provide proof of identity for both you and your child.

Here's our roundup of the best current accounts for children.

The free Starling Kite account from Starling Bank is open to kids from as young as six to as old as 15 and can be opened online.

Parents can set all sorts of controls over the account, from how much that can be spent and whether it can be used online.

You can also ensure that you get notifications whenever money is spent on the account, so you can keep an eye on your child's money habits.

As with the normal Starling account, you can set savings goals to help educate your child about the benefits of saving money regularly and get them into the savings habit.

The account can be topped up as and when you need to, or you can set up regular payments of pocket money.

As an added bonus, the bank also allows kids with a Kite account to earn 3.25% AER on money an adult puts aside in a linked current account on the child's behalf. You can do this by creating a dedicated Kite savings 'Space' within your current account.

Be aware, the 3.25% rate only applies to the first £5,000 in overall deposits within your current account.

Head this way to learn more about the Kite account.

HSBC MyMoney/MySavings (7-17)

HSBC MyMoney is a current account for children aged 11 to 17. It doesn't offer much in the way of perks like interest, but you can combine it with a MySavings account.

MySavings is available to children between the ages of seven and 17 and pays a rate of 5% on balances of up to £3,000 and 2.25% on balances over this amount.

MyMoney comes with a Visa debit card, allowing your child to shop online and in-store, as well as withdraw money from an ATM.

If your child is under the age of 11, they'll get a cash book, which they can use to take money out at any HSBC branch - but they'll need a parent or guardian's permission and signature to take out £50 or more.

The account can be managed online, through the mobile banking app and over the phone, as well as in an HSBC branch.

If the parent or guardian is an HSBC customer, they can apply for their child's account online, but if not, they'll have to go in-branch to open an account.

You need to provide ID and proof of address for the child and yourself. If your child is over the age of 16, you won't need to accompany them to your local branch.
HSBC has warned customers that it might take longer than usual to process their applications at this time.
TSB Under 19s (11-17)

The TSB Under 19s account can be opened for 11 to 17-year-olds. It pays an attractive 2.50% rate of interest on balances of up to £2,500.

On top of that, once your child turns 17, they'll also get driving discounts.

They could save £36 on AA driving lessons and get £20 off a Pass Plus course, which teaches advanced driving skills.

The account comes with a Visa debit card to use in shops, online or at cash machines (with a maximum daily withdrawal limit of £500).

Apple Pay can be used by children over the age of 13, while Google Pay can only be used by those at least 16 years old.

Kids can manage their account in branch, as well as online, over the phone and through the mobile app, but age restrictions may apply.

Accounts can only be opened in a branch. Children between the ages of 11 and 15 must be accompanied by a parent or a guardian.

Two forms of ID such as a passport or birth certificate will be needed for the child, as well as proof of the parent or guardian's identity and address.

Those over the age of 16 do not need to be accompanied by a parent or guardian but will have to bring ID and proof of their address to a branch.

Santander 123 Mini (0-17)

The Santander 123 Mini current account is available for kids up to the age of 17. It pays tiered rates of interest.

Your child will be able to earn 1% on balances of up to £999, 2% interest for balances between £1,000 and £1,499 and 3% interest for balances between £1,500 and £2,000.

The account comes with the choice of a cash card that limits your child to taking money out of ATMs, or a Santander debit card, which also allows them to shop online and in stores.

Kids can keep track of their money via text and email alerts, over the phone, online, through mobile banking or in a branch.

You can apply for an account online if your child is between the ages of 13 and 17, or by going to a local branch if they are under 13 years old.

The 123 Mini account must be opened in trust and managed by an adult (who has a Santander current account) if the child is under the age of 13. You'll need proof of your name and address, and your child's name to open an account.

NatWest Adapt Bank Account (11-17)

The NatWest Adapt account is available to children aged 11 to 17.

It allows them to earn 2.7% interest on any credit balance in the account. The interest is calculated daily and paid monthly.

The account comes with a Visa debit card to use in shops or online, and your child can take out up to £130 a day.

They can manage the account through text alerts, online, through the mobile banking app, in a branch or over the phone.

You can apply for an account online or in a branch. If your child is under 16, you need to open an account on their behalf and need to have a NatWest current account.

You might be able to upload proof of identity and address for yourself and your child when you apply online, but this depends on the application.

So, you may need to pop into a branch to show these documents.

Alternatively, NatWest offers Rooster Money, a pocket money app managed by parents or legal guardians but you may be charged for using this app.

Nationwide FlexOne (11-17)

The Nationwide FlexOne account is available to 11 to 17-year-olds. The account pays 2% interest on balances of up to £1,000.

Nationwide FlexOne offers the choice of a cash card or a contactless Visa debit card. Both have a maximum daily withdrawal limit of £300, but the FlexOne cash card only lets you withdraw money from ATMs.

The Visa card lets you make payments in stores and online.

The account can be managed through text alerts, online, through the mobile app, over the phone, as well as in a Nationwide branch.

If you're applying online (which won't be possible for accounts for 11 to 12-year-olds), any ID such as a passport, birth certificate or proof of address, may need to be checked in a branch.
At the time of writing, Nationwide only accepts FlexOne applications for 11-12-year-olds at certain branches with a tablet, while those between the ages of 13 and 17 can apply online.
Lloyds Bank Under 19s (11-17)

Despite its name, the Lloyds Bank Under 19s account is open to applications from children aged 11 to 17. It pays 0.5% interest on balances of up to £999.99 and no interest on balances above this amount.

The account comes with the choice of a Cashpoint card, allowing kids to withdraw money from cash machines or a Visa debit card, which also allows them to pay for things in shops or online.

The limit on daily cash withdrawals is £200 for a Cashpoint card and up to £500 for a Visa debit card.

The account comes with a Save the Change option. Each time your child purchases something with their Visa card, the amount is rounded up to the nearest pound and transferred into a Lloyds Bank savings account of their choice.

Once your child turns 18, they can receive up to 15% cashback via Everyday Offers.

Kids can manage their money through text alerts, online banking, through the mobile app, over the phone and in a branch.

'Money Manager' automatically breaks down your child's spending to help them understand how much they are spending and where, as well as help set up a savings goal.

The method for opening an account will depend on the age of your child.

11 to 12-year-olds must have a parent or guardian with them to apply for the account and it must be done in a branch.

Children between the ages of 13 and 15 also must have a parent or guardian to help them open the account, but they can fill out the application form online.

They'll then need to pop into a Lloyds branch with their proof of identity, while the parent/guardian needs to provide proof of their identity and address.

For 16 to 17-year-olds, the account can be opened online (and ID can be provided) although you might need to visit a branch to provide identification if it can't be checked online. There's no need for a parent or guardian to accompany the child.
The best bank accounts for cashback Lloyds Bank recommends that those aged 13-17 start their application online.
Halifax Expresscash (11-17)

The Halifax Expresscash account is tailored for children aged 11 to 17. It offers 0.5% credit interest on balances between £1 and £999.99.

The Halifax account comes with a Visa debit card, which has a maximum withdrawal limit of £500 a day. Your child can manage the account via text alerts, online, through the mobile app, in a branch or over the telephone.

Similar to Lloyds, the method of opening an account will depend on the age of your child.

Kids aged 11 to 12 need to be with a parent or guardian and the account can only be opened in a branch. Proof of ID and proof of the parent or guardian's identity and address will need to be provided.

Those aged between 13 and 15 can apply online, and then visit a branch with a parent or guardian to provide the necessary identification.

For 16 to 17-year-olds, the account can be opened online (and ID can be provided) although you might need to visit a branch to provide identification if it can't be checked online. There's no need for a parent or guardian to accompany the child.
Halifax recommends applicants aged between 13 and 17 start their application online.
Barclays BarclayPlus (11-15)

The BarclayPlus account is available to 11 to 15-year-olds. It allows your child to earn 0.1% on balances of over £1 and 0.6% on balances of over £1,000.

The account comes with a cash card or a Visa debit card. With the cash card, the account holder can withdraw up to £50 a day from cash machines. If they have the Visa card, they can make withdrawals of up to £300 a day, as well as using the card in shops and online.

If the parent or guardian banks with Barclays, an application can be made via the Video Banking app, but if not, an application will have to be made in a branch.

The child will need to bring ID, while proof of address and identity is required for the parent or guardian.

While it doesn't have all the features of a children's bank account, the gohenry finance app is available to kids as young as six, so could be worth considering if you want to teach your kids about money from a younger age.

The app aims to make it easier for parents to give their children the freedom to spend any pocket money in a safe way while teaching them how to be good with money.

As such, it offers in-app financial education through its Money Missions feature.

There's no overdraft available so there's no risk of your child racking up debt and charges.

On the upside, there's no need to trek to your local bank branch to set it up.

You simply download the app, sign up and your child's prepaid card will arrive within seven working days. Once you get the card, you log into the website or app to activate your parent account and the card.

If you're curious about the app, there's a one-month free trial.

After that, you'll pay £3.99 a month per child on its Everyday plan. You'll also have the option to upgrade to a Plus plan for £5.99 per month per child, which also offers 1% cashback on in-store spending and pays 4.5% AER on savings. Your kids will also have greater access to the app's Money Missions feature.

You can read our full gohenry review here.

HyperJar (6-17)

The great thing about HyperJar is that it's free to use, although it does lack some of the functionality and flexibility of the accounts mentioned above.

Parents can set up an account for a child between the ages of six and 17, but it must be linked to their own HyperJar account.

HyperJar doesn't work like a normal bank account where there is one pot of money. Instead, you put money into small pots, or 'jars', that you can then let your kids access with their card.

So, for example, you could set up a 'pocket money' jar that you pay a set amount into each week or month. Or you could be more specific and set up a jar for entertainment, one for treats, and so on.

Don't worry, you can apply spending caps on any jar to ensure that your child doesn't spend it all at once!

You can schedule regular payments and your child can download the app so they can see their own jars and link their card to jars themselves.

Both parents and kids get spending notifications, and any jars can be shared, plus your child can never go overdrawn with HyperJar.

The one downside is that money cannot be withdrawn from an ATM with this card.
*This article contains affiliate links, which means we may receive a commission on any sales of products or services we write about. This article was written completely independently.
Check out our full review here.

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The best UK bank accounts for kids and teenagers

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On the hunt for a current account for your kids? Here are our top UK bank accounts for 11-18-year-olds.

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Similar to the Direct Payments explained earlier in this guide, the NHS offers Personal Health Budgets to adults who need care and support that would organised and funded by the NHS.

If your young person regularly receives NHS services or support and you would like to consider a Personal Health Budget for them, you should ask the healthcare professional that oversees their care or their GP. Click this link for more information: NHS England » Frequently asked questions about PHBs

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Personal Budgets & Personal Health Budgets - what's the difference?

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Personal Budgets & Personal Health Budgets - what's the difference?

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Personal Budgets for Education and Social Care

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Personal Budgets for Education and Social Care

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A Personal Budget is an amount of money which is given to an individual or their family carers to enable them to find and pay for their own support. A Personal Budget can pay for the support that your child needs to help them achieve some of the educational or social care outcomes listed within their EHC Plan. It is money that is paid instead of (not as well as) some other services that your child might overwise use. This money does not affect other benefits and is not means-tested for those under age 18.

Personal Budgets were introduced to give young people and their families more control over the kind of support that they receive. Personal Budgets can allow you as parents and carers to make the decisions about what support is best for your child's preferences and lifestyle, who provides it and how it is provided, rather than these decisions being made for your child and family by other professionals.

A Personal Budget is not designed to replace all of the services that your child might need, but it can replace some of them, to give you the freedom and flexibility to tailor the support that they need. Personal budgets might pay for support workers or personal assistants, special equipment or adaptations, activity costs or transport into the community.

Any young person with an EHC Plan, or their parents or carers, can ask Central Bedfordshire Council to prepare a personal budget for them. Personal Budgets are not compulsory and you are not obligated to accept the personal budget just because you have asked for one to be created. The Council will first prepare a draft budget that should show an amount of money that is sufficient to cover the cost of the support needed to help your child meet the relevant outcome(s) within their EHC Plan. The draft budget is only a starting point and will only be finalised once everyone is satisfied that it can meet the needs of your child.

Once agreed, the money that is put into the child's Personal Budget can be managed by the local authority or by the family themselves. If the family is paid the money and manages it themselves, this is usually done via a regular monthly payment which is called a Direct Payment.

Sometimes the Local Authority might not agree to a Personal Budget; but if this is the case they must tell you why.

If you are interested in requesting a personal budget for any of your child's educational or social care needs or EHCP outcomes, you can contact the EHC Team:

The EHC Team 0300 300 8356

ehcenquiries@centralbedfordshire.gov.uk

More information about personal budgets for education and social care can be found here:

personal-budgets-3_tcm3-14184.pdf (centralbedfordshire.gov.uk)

personal-budget-guide_tcm3-4942.pdf (centralbedfordshire.gov.uk)

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Personal Health Budgets can help those with long term health conditions to pay for care at home, or to buy equipment, or to participate in activities that help them stay as well as possible.

If you are interested in a Personal Health Budget you can contact the Personal Health Budgets Team at the Bedfordshire, Luton and Milton Keynes Integrated Care Board:

01525 624402 blmkicb.phb@nhs.net

More information about who qualifies for a Personal Health Budget can be found here:

Personal Health Budgets - BLMK Integrated Care Board (icb.nhs.uk)

PHB-easy-read-final-version-6.pdf (england.nhs.uk)

on-6.pdf

What is a personal health budget? - NHS (www.nhs.uk)

If you are interested in a Personal Wheelchair Budget you can contact:

Bedfordshire & Luton Wheelchair Service

03456 024064 elft.wheelchairs.admin@nhs.ne

Personal Wheelchair Budgets | Central Bedfordshire SEND Local Offer

NHS England » Frequently asked questions

Bedfordshire and Luton Wheelchair Service | East London NHS Foundation Trust (elft.nhs.uk)

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Some specialist colleges for people with disabilities offer accommodation for the young adults attending the college. This might be within a residential care home or supported-living accommodation that is close to the college. This can allow the young adult to live independently from their families whilst also attending college. Click the image above to find out more about specialist colleges within the UK.

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Natspec is the membership association for organisations that offer specialist further education and training for students with learning difficulties and/or disabilities aged 16 to 25.
Our vision

Our vision is that

all young people with learning difficulties or disabilities can access high quality education and training, which meets their individual needs and supports their aspirations for skills, work and life.

Our mission and values
Natspec exists to improve Further Education (FE) for students with learning difficulties and/or disabilities.
We value specialism and personalisation within a diverse range of FE and training provision - an inclusive FE system. This education should broaden choice for young people, support their aspirations, represent their best interests and provide a social return on investment. An inclusive FE system is underpinned by three key principles:

Equality of opportunity and access

Learners views shaping the system

FE preparing young people to be included in wider society

Our policy priorities and recommendations to government aim to address many of the barriers that currently exist for young people with learning difficulties and/or disabilities.

What we do

Our core activities are to:

1. Support and inform our members to help them raise the quality of provision for learners. To help improve quality, we provide guidance and briefings, offer quality health checks, and deliver events, networks and conferences to our members. We also help our members provide advice and guidance to young people, their families and supporters.

2. Influence policy and act as an advocate for specialism in FE to create a system that works for learners. We represent members to government, funding agencies and other stakeholders, including through the use of student voice and by publishing papers and reports. We highlight the positive difference members can make to the lives of young people with SEND/ALN through our student stories, directory, website, Natspec Highlights, social media and articles.

3. Support the wider FE sector to improve quality of provision for all young people with learning difficulties and/or disabilities. We provide training and development through the Natspec Transform and TechAbility services. Our projects and partnerships support professionals throughout the sector. We provide opportunities for students to engage in inter-college activities such as the Natspec Games and Student Parliament. We also contribute to the work of other organisations who seek to improve the lives of people with disabilities.

What our members provide

Member colleges provide:

Challenging but safe adult environments which encourage students to develop personally and socially

Specialist multi-disciplinary teams with expertise in teaching, learning support, therapies and assistive technologies which enable students to learn effectively

High quality, personalised Study Programmes linked to Education, Health and Care plans, which support students to achieve their aspirations for work or higher education; living more independently with greater choice and control; having friendships, supportive relationships and being involved in the community, and leading a healthy lifestyle

Opportunities for students to develop their communication skills, express their views, and make choices and decisions.

To promote continuing improvement and innovation, member colleges:

Work in partnership with students and their families, with other members, with other education and training providers, and with local and national agencies

Ensure that staff are suitably experienced and qualified and have regular opportunities to update their professional practice.

Disability Confident

As part of its on-going determination to increase opportunities for disabled people to find and retain jobs, Natspec has signed up to the Government's Disability Confident scheme . We are committed to offering work experience and work shadowing opportunities for college students.

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Natspec is the membership association for organisations which offer specialist further education and training for students with learning difficulties and/or disabilities.

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SEN Legal Webinar - Social Care, Child to Adult Transition

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Leave a comment at the bottom of a section to ask a question, tell us what was helpful or unhelpful about the information, or if any of the issues need further or clearer explanation. Tell us what help or advice you think is missing or what other topics or information you would like to see included within this guide.

This helps us to keep improving and expanding the information so that other young people and their families can continue to benefit from this guide.

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Health support for Adults with a Learning Disability

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Health support for Adults with a Learning Disability

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Special Services for People with a Learning Disability (SPLD) are a team dedicated to helping adults with learning disabilities to get the health care that they need. Contact them on 01234 310589 or email Elt-tr.spldreferrals@nhs.net

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We help people with their healthcare needs. We might work with you, your family or carers, and other professionals, including social workers.

We support people to live healthy and happy lives, and to get the support they need.

We support people with physical, mental health, and behavioural support needs.

We also work to help adults with Learning Disabilities access other mainstream services, like mental health and physical health services.
We have different professionals on the team:

Arts Therapists

Health Facilitation

Nurses

Occupational Therapists

Physiotherapists

Positive Behaviours Support Practitioners

Psychiatrists

Psychologists

Speech and Language Therapists

They are supported by operational managers and admin staff.

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learning disabilities specialist community healthcare luton

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Specialist Services for People with a Learning Disability (Bedfordshire and Luton) | East London NHS Foundation Trust

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Learning disabilities services in Bedfordshire and Luton are provided by Services for People with a Learning Disability (SPLD).

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What should happen for my child when they reach age 14?

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What should happen for my child when they reach age 14?

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From age 14 (year 9 onwards), your young person should always be asked about their wishes and aspirations for their future life as a teenager and as an adult.

All of the support that they receive at school or college, from health services, or from social care, should focus on helping to prepare them to achieve the things that are important to them in adulthood.

Any plans being made with them or for them must be focused around their wishes, aspirations or ambitions for the future, and should be designed to help them get ready to live the life that they want as an adult.

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If you are over 16 years of age and you provide at least 35 hours a week of unpaid care and support to a person of any age who is receiving certain benefits, you may be able to claim Carers Allowance. This is a weekly amount paid to you to support you in your caring role. In order to claim you must not be studying for more than 21 hours a week, and your net earnings must be less than £151 a week (after tax and national insurance deductions).

Find out if you are eligible for Carers Allowance and how to apply here: Carer's Allowance: Eligibility - GOV.UK (www.gov.uk)

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A Deputyship is when somebody is appointed by the Court of Protection to make decisions for someone else who is unable to make them for themselves. This would usually be a family member or close friend. There are two kinds of Deputyship. A financial Deputyship allows the Deputy to manage the person's finances and property. A health & welfare Deputy can manage other decisions for the person.

The application to become a Deputy for someone is made to the Court of Protection Court of Protection - GOV.UK (www.gov.uk) who will consider each application very carefully, particularly for health & welfare. Once a Deputyship is awarded, the Deputy can make all of the decisions that the person is not able to make for themselves. However, the Deputy is still expected to allow the person to make whatever decisions that can, and should still consult other people involved in their care when making decisions for them.

A Deputyship is not the same as a Lasting Power of Attorney (LPA). An LPA can only be made when a person has full mental capacity in readiness for a time when they do not. A Deputyship is needed where a person does not have capacity to consent to someone acting on their behalf.

Deputies - legal information - Mind

Deputies: make decisions for someone who lacks capacity: Overview - GOV.UK (www.gov.uk)

Common questions and misconceptions about the role of Deputies (penningtonslaw.com)

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The Role of the Court of Protection Deputy - What is it?

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Shared-lives is a scheme that allows a carer to share their home and family life with an adult who needs support. The scheme carefully matches an adult with disabilities to a carer and family that is right for them. Some people move in with their shared-lives carer, while others might continue to live with their families but be regular day visitors. Before any permanent move, the adult will have the chance to get to know the shared-lives carer and their family, to decide whether they are a good fit for them. Shared-lives can be a first step towards greater independence and can help young people become established within a community before moving into a home of their own.

Adults being supported within a shared-lives setting are financially assessed in the same way as for supported-living, and will be required to make a contribution towards the cost of their shared lives placement.

Find out more about shared lives here: Is Shared Lives right for you? (ategi.org.uk)

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Shared Lives - Liam and Paul’s story of living with Karen and her family

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Applying to join the Central Bedfordshire Housing Register

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Applying to join the Central Bedfordshire Housing Register

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Your young adult can apply to be put onto the Central Bedfordshire housing register to try and secure social housing from the local authority directly or through a housing association. Click the image above that will explain the process and how to get started.

More information about applying for a home through the council can be found here: Applying for accessible council and housing association homes | Disability charity Scope UK

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How to apply for the housing register | Central Bedfordshire Council

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Making financial contributions towards the cost of care and support

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Making financial contributions towards the cost of care and support

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The local authority will carry out a financial assessment of your young person to see if they are required to make a contribution towards the cost of their care and support as an adult. This assessment is based on the assets, income and expenditure of the young person, and is not affected by the assets or income of their family members, carers or anyone else they may live with. The financial contributions that an adult will need to pay towards the cost of their care are different for residential and non-residential care and support.

For residential care homes, many of the young person's benefits will stop when the move in because all of their accommodation and living expenses (including food) are paid for as part of their residential home. However, they will still receive the mobility component of DLA or PIP. Any other benefits or income that they receive will be used to assess what their contribution towards the cost of their care will be. The rules for these contributions are currently the same for both younger and elderly adults. Usually for a younger adult their contribution will simply be their total income less a Personal Allowance of £30.15 per week. This personal allowance is the money that they can keep to spend on personal items, but must usually also cover clothing and any activity costs that are not provided by the care home. Therefore, when considering residential care it is important to think about whether this weekly Personal Allowance plus the mobility element of their DLA or PIP will be enough to pay for their personal and activity expenses.

Paying for residential care: Paying-for-residential-care-leaflet.pdf (centralbedsappp.co.uk)

For non-residential care and support, all of the adults benefit income (excluding the mobility element of DLA or PIP) is considered when their contribution is calculated. However, as the young person is paying for and managing their own food, household bills and living expenses, they must be left with a set amount each week called the Minimum Income Guarantee. This is an amount of money set nationally by the government each year and is currently £110.60 per week. However, people with disabilities are often entitled to a higher Minimum Income, and may have a disability premium of £48.80 and an enhanced disability premium of £23.85 added to the standard Minimum Income amount. The local authority must not leave a disabled person with less money each week than the Minimum Income Guarantee that they are entitled to, when setting their care contribution.

In addition to the Minimum Income Guarantee, the local authority must also take into account any disability related expenditure when setting the amount of a person's contribution. Disability related expenditure is any regular products or services that the adult has to pay for because of their disability, and these expenses will need to be evidenced by showing receipts or invoices. Disability related expenditure will reduce the amount of the contribution that the person has to make towards the cost of their care and support.

Paying for non-residential care: Paying-for-non-residential-care-leaflet-1.pdf (centralbedsappp.co.uk)

Whilst the amount of assets or savings held by an adult can also affect the amount of their financial contribution, this is not until these exceed £14,250 in value. In reality, most younger adults accessing care and support are unlikely to be holding this level of assets or savings and so will be unaffected.

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This statutory guidance sets out how local authorities must provide care and support, and includes the rules around charging and financial assessments.

Details of the most recent Personal Allowance rates, Minimum Income Guarantee amounts, and savings thresholds, can be found here: Social care - charging for care and support: local authority circular - GOV.UK (www.gov.uk)

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Using the Care Act guidance

This publication is currently under review

The Health and Care Act 2022 revoked Schedule 3 and amended Section 74 of the Care Act 2014 on 1 July 2022. This means that certain parts of this guidance are out of date and in the process of being updated to reflect the relevant statutory changes.

How to search the guidance

On your keyboard, press Ctrl + F on a PC or Command + F on a Mac

This will open a search box in the top right hand corner of the page. Type the word you are looking for in the search bar and press enter. The word will then be highlighted in yellow where every it appears in the guidance. Click on the enter key to move to the next word found.

How to print a copy of the guidance

On your keyboard, press Ctrl + P on a PC or Command + P on a Mac

You have an option to print the entire Care Act guidance (approximately 375 pages) or select a page range.

General responsibilities and universal services

This section includes chapters on:

1. Promoting wellbeing 2. Preventing, reducing or delaying needs 3. Information and advice 4. Market shaping and commissioning of adult care and support 5. Managing provider failure and other service interruptions

1. Promoting wellbeing

This chapter provides guidance on section 1 of the Care Act 2014 and covers:

1.1 The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. Throughout this guidance document, the different chapters set out how a local authority should go about performing its care and support responsibilities. Underpinning all of these individual 'care and support functions' (that is, any process, activity or broader responsibility that the local authority performs) is the need to ensure that doing so focuses on the needs and goals of the person concerned.

1.2 Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as 'the wellbeing principle' because it is a guiding principle that puts wellbeing at the heart of care and support.

1.3 The wellbeing principle applies in all cases where a local authority is carrying out a care and support function, or making a decision, in relation to a person. For this reason it is referred to throughout this guidance. It applies equally to adults with care and support needs and their carers .

1.4 In some specific circumstances, it also applies to children, their carers and to young carers when they are subject to transition assessments (see chapter 16 on transition to adult care and support).

Definition of wellbeing

1.5 'Wellbeing' is a broad concept, and it is described as relating to the following areas in particular:

1.6 The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering 'wellbeing' in the round.

1.7 Promoting wellbeing involves actively seeking improvements in the aspects of wellbeing set out above when carrying out a care and support function in relation to an individual at any stage of the process from the provision of information and advice to reviewing a care and support plan. Wellbeing covers an intentionally broad range of the aspects of a person's life and will encompass a wide variety of specific considerations depending on the individual.

1.8 A local authority can promote a person's wellbeing in many ways. How this happens will depend on the circumstances, including the person's needs, goals and wishes, and how these impact on their wellbeing. There is no set approach - a local authority should consider each case on its own merits, consider what the person wants to achieve, and how the action which the local authority is taking may affect the wellbeing of the individual.

1.9 The Act therefore signifies a shift from existing duties on local authorities to provide particular services, to the concept of 'meeting needs' (set out in sections 8 and 18 to 20 of the Act). This is the core legal entitlement for adults to care and support, establishing one clear and consistent set of duties and power for all people who need care and support.

1.10 The concept of meeting needs recognises that everyone's needs are different and personal to them. Local authorities must consider how to meet each person's specific needs rather than simply considering what service they will fit into. The concept of meeting needs also recognises that modern care and support can be provided in any number of ways, with new models emerging all the time, rather than the previous legislation which focuses primarily on traditional models of residential and domiciliary care.

1.11 Whenever a local authority carries out any care and support functions relating to an individual, it must act to promote wellbeing - and it should consider all of the aspects above in looking at how to meet a person's needs and support them to achieve their desired outcomes. However, in individual cases, it is likely that some aspects of wellbeing will be more relevant to the person than others. For example, for some people the ability to engage in work or education will be a more important outcome than for others, and in these cases 'promoting their wellbeing' effectively may mean taking particular consideration of this aspect. Local authorities should adopt a flexible approach that allows for a focus on which aspects of wellbeing matter most to the individual concerned.

1.12 The principle of promoting wellbeing should be embedded through the local authority care and support system, but how the local authority promotes wellbeing in practice will depend on the particular function being performed. During the assessment process, for instance, the local authority should explicitly consider the most relevant aspects of wellbeing to the individual concerned, and assess how their needs impact on them. Taking this approach will allow for the assessment to identify how care and support, or other services or resources in the local community, could help the person to achieve their outcomes. During care and support planning, when agreeing how needs are to be met, promoting the person's wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family). To give another example, the concept of wellbeing is very important when responding to someone who self-neglects, where it will be crucial to work alongside the person, understanding how their past experiences influence current behaviour. The duty to promote wellbeing applies equally to those who, for a variety of reasons, may be difficult to engage.

1.13 The wellbeing principle applies equally to those who do not have eligible needs but come into contact with the system in some other way (for example, via an assessment that does not lead to ongoing care and support) as it does to those who go on to receive care and support, and have an ongoing relationship with the local authority. It should inform the delivery of universal services which are provided to all people in the local population, as well as being considered when meeting eligible needs. Although the wellbeing principle applies specifically when the local authority performs an activity or task, or makes a decision, in relation to a person, the principle should also be considered by the local authority when it undertakes broader, strategic functions, such as planning, which are not in relation to one individual. As such, wellbeing should be seen as the common theme around which care and support is built at local and national level.

1.14 In addition to the general principle of promoting wellbeing, there are a number of other key principles and standards which local authorities must have regard to when carrying out the same activities or functions:

1. a) The importance of beginning with the assumption that the individual is best-placed to judge the individual's wellbeing. Building on the principles of the Mental Capacity Act, the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing. Local authorities should not make assumptions as to what matters most to the person.

2. b) The individual's views, wishes, feelings and beliefs. Considering the person's views and wishes is critical to a person-centred system. Local authorities should not ignore or downplay the importance of a person's own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.

3. c) The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person's needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer (see chapter 2 on prevention).

4. d) The need to ensure that decisions are made having regard to all the individual's circumstances (and are not based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the person's circumstances, but should in every case work to understand their individual needs and goals.

5. e) The importance of the individual participating as fully as possible. In decisions about them and being provided with the information and support necessary to enable the individual to participate. Care and support should be personal, and local authorities should not make decisions from which the person is excluded.

6. f) The importance of achieving a balance between the individual's wellbeing and that of any friends or relatives who are involved in caring for the individual. People should be considered in the context of their families and support networks, not just as isolated individuals with needs. Local authorities should take into account the impact of an individual's need on those who support them, and take steps to help others access information or support.

7. g) The need to protect people from abuse and neglect. In any activity which a local authority undertakes, it should consider how to ensure that the person is and remains protected from abuse or neglect. This is not confined only to safeguarding issues, but should be a general principle applied in every case including with those who self-neglect.

8. h) The need to ensure that any restriction on the individual's rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary. For achieving the purpose for which the function is being exercised. Where the local authority has to take actions which restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary. Concerns about self-neglect do not override this principle.

1.15 All of the matters listed above must be considered in relation to every individual, when a local authority carries out a function as described in this guidance. Considering these matters 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 - as well as the other people in their life and how they can support the person in meeting the outcomes they want to achieve. The focus should be on supporting people to live as independently as possible for as long as possible.

1.16 As with promoting wellbeing, the factors above will vary in their relevance and application to individuals. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. Local authorities should consider how to apply these further principles on a case-by-case basis. This reflects the fact that every person is different and the matters of most importance to them will accordingly vary widely.

1.17 Neither these principles, nor the requirement to promote wellbeing, require the local authority to undertake any particular action. The steps a local authority should take will depend entirely on the circumstances. The principles as a whole are not intended to specify the activities which should take place. Instead, their purpose is to set common expectations for how local authorities should approach and engage with people.

Independent living

1.18 Although not mentioned specifically in the way that wellbeing is defined, the concept of 'independent living' is a core part of the wellbeing principle. Section 1 of the Care Act includes matters such as individual's control of their day-to-day life, suitability of living accommodation, contribution to society - and crucially, requires local authorities to consider each person's views, wishes, feelings and beliefs.

1.19 The wellbeing principle is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention). Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The language used in the Act is intended to be clearer, and focus on the outcomes that truly matter to people, rather than using the relatively abstract term 'independent living'.

Wellbeing throughout the Care Act

1.20 Wellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting people to live as independently as possible for as long as possible. (See chapter 2 for more detail on approaches to prevention).

1.21 Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people's needs for care and support and how meeting these can help them achieve the outcomes most important to them. Where someone is unable to fully participate in these conversations and has no one to help them, local authorities will arrange for an independent advocate. Chapters 6 (Assessment and eligibility), 10 (Care and support planning), and 7 (Independent advocacy) discuss this in more detail.

1.22 In order to ensure these conversations look at people holistically, local authorities and their partners must focus on joining up around an individual, making the person the starting point for planning, rather than what services are provided by what particular agency. Chapter 15 (integration and cooperation) sets this out in more detail.

1.23 In particular, the Care Act is designed to work in partnership with the Children and Families Act 2014, which applies to 0 to 2.5 year old children and young people with SEN and Disabilities. In combination, the 2 Acts enable areas to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. This is considered in more detail at chapter 16.

1.24 Promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them. People will have an opportunity to request their local authority support in the form of a direct payment that they can then use to buy their own care and support using this information. Chapters 3 (Information and advice) and 12 (Direct payments) explain this in more detail.

1.25 Control also means the ability to move from one area to another or from children's services to the adult system without fear of suddenly losing care and support. The Care Act ensures that people will be able to move to a different area without suddenly losing their care and support and provides clarity about who will be responsible for care and support in different situations. It also includes measures to help young people move to the adult care and support system, ensuring that no one finds themselves suddenly without care on turning 18. Chapters 20 (Continuity of care), 19 (Ordinary residence) and 16 (Transition to adult care and support) set this out in more detail.

1.26 It is not possible to promote wellbeing without establishing a basic foundation where people are safe and their care and support is on a secure footing. The Care Act puts in place a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services. Chapters 14 (Safeguarding), and 5 (Managing provider failure) set this out in more detail.

The role of the Principal Social Worker in care and support

1.27 The purpose of this section of the guidance is to further clarify arrangements to have in place a designated principal social worker in adult care and support. Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:

lead and oversee excellent social work practice

support and develop arrangements for excellent practice

lead the development of excellent social workers

support effective social work supervision and decision making

oversee quality assurance and improvement of social work practice

advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice

function at the strategic level of the Professional Capabilities Framework

The local authority role in supporting principal social workers

1.28 All local authorities should ensure principal social workers are given the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level and are given sufficient time to carry out their role. The principal social worker should also be visible across the organisation, from elected members and senior management, through to frontline social workers, people who use services and carers. Local authorities should therefore ensure that the role is located where it can have the most impact and profile.

1.29 Whatever arrangements are agreed locally, the principal social worker should maintain close contact with the DASS and frontline practitioners and engage in some direct practice. This can take several different forms, including direct casework, co-working, undertaking practice development sessions, mentoring.

1.30 The integration of health and care and support will increasingly require social workers to lead, both in their teams and across professional boundaries, particularly in the context of safeguarding, mental health and mental capacity. Organisational models of social work have traditionally focused on managerial, as opposed to professional leadership - through their direct link to practice, principal social workers can 'bridge the gap' between professional and managerial responsibility, to influence the delivery and development of social work practice.

Principal social workers and safeguarding

1.31 Chapter 14 of this statutory guidance endorses the: 'Making Safeguarding Personal' approach. This represents a fundamental shift in social work practice in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers should have a broad knowledge base on safeguarding and Making Safeguarding Personal and be confident in its application in their own and others' work. Local authorities should, therefore, ensure that principal social workers lead on ensuring the quality and consistency of social work practice in fulfilling its safeguarding responsibilities. In particular they should have extensive knowledge of the legal and social work response options to specific cases and in general.

2. Preventing, reducing or delaying needs

This chapter provides guidance on section 2 of the Care Act 2014.

This chapter covers:

2.1 It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it will be vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible.

2.2 There are many ways in which a local authority can achieve the aims of promoting wellbeing and independence and reducing dependency. This guidance sets out how local authorities should go about fulfilling their responsibilities, both individually and in partnership with other local organisations, communities, and people themselves.

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

2.4 The term 'prevention' or 'preventative' measures can cover many different types of support, services, facilities or other resources. There is no single definition for what constitutes preventative activity and this can range from wide-scale whole-population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one person or a particular group or lessening the impact of caring on a carer's health and wellbeing. In considering how to give effect to their responsibilities, local authorities should consider the range of options available, and how those different approaches could support the needs of their local communities.

2.5 'Prevention' is often broken down into 3 general approaches - primary, secondary and tertiary prevention - which are described in more detail below. The use of such terms is aimed to illustrate what type of services, facilities and resources could be considered, arranged and provided as part of a prevention service, as well as to whom and when such services could be provided or arranged. However, services can cut across any or all of these 3 general approaches and as such the examples provided under each approach are not to be seen as limited to that particular approach. Prevention should be seen as an ongoing consideration and not a single activity or intervention.

2.6 These are aimed at individuals who have no current particular health or care and support needs. These are services, facilities or resources provided or arranged that may help an individual avoid developing needs for care and support, or help a carer avoid developing support needs by maintaining independence and good health and promoting wellbeing. They are generally universal (for example, available to all) services, which may include, but are not limited to interventions and advice that:

The LinkAge programme aims to promote and enhance the lives of older people (55+ years old) through a range of activities, from walking groups to coffee mornings, through a number of older people-led 'hubs' across the city. The main aim is to bring those people that feel socially isolated and lonely into their local communities. In an evaluation of a new hub there was significant improvement on a friendship scale with scores moving from people feeling isolated or with a low level of social support at the beginning of the hub to very or highly socially connected at follow up.

Eileen (85) said:

I look forward to Fridays each week and enjoy the social aspect of the club too."

Lyn said:

if it wasn't for LinkAge I don't quite know what would have happened. It's made life bearable, well more than bearable, it's made it life."

Reduce: secondary prevention/early intervention

2.7 These are more targeted interventions aimed at individuals who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing. Some early support can help stop a person's life tipping into crisis, for example helping someone with a learning disability with moderate needs manage their money, or a few hours support to help a family carer who is caring for their son or daughter with a learning disability and behaviour that challenges at home.

2.8 Early intervention could also include a fall prevention clinic, adaptions to housing to improve accessibility or provide greater assistance, handyman services, short term provision of wheelchairs or telecare services. In order to identify those individuals most likely to benefit from such targeted services, local authorities may undertake screening or case-finding, for instance to identify individuals at risk of developing specific health conditions or experiencing certain events (such as strokes, or falls), or those that have needs for care and support which are not currently met by the local authority. Targeted interventions should also include approaches to identifying carers, including those who are taking on new caring responsibilities. Carers can also benefit from support to help them develop the knowledge and skills to care effectively and look after their own health and wellbeing.

Delay: tertiary prevention/formal intervention

2.9 These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired (see also chapter 22 sight registers). Local authorities must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as the provision of formal care such as meeting a person's needs in their own home; rehabilitation/reablement services, for example, community equipment services and adaptations; and the use of joint case-management for people with complex needs.

2.10 Tertiary prevention services could also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through respite care, peer support groups like dementia cafés, or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others. This can help develop mechanisms to cope with stress associated with caring and help carers develop an awareness of their own physical and mental health needs.

2.11 Prevention is not a one off activity. For example, a change in the circumstances of an adult and/or carer may result in a change to the type of prevention activity that would be of benefit to them (see para 2.32). Prevention can sometimes be seen as something that happens primarily at the time of (or very soon after) a diagnosis or assessment or when there has been a subsequent change in the person's condition. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.

2.12 There is a tendency for the terms 'reablement', 'rehabilitation' and 'intermediate care' to be used interchangeably. The National Audit of Intermediate Care categorises 4 types of intermediate care:

2.13 The term 'rehabilitation' is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

2.14 'Intermediate care' services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently - as such they provide a link between places such as hospitals and people's homes, and between different areas of the health and care and support system - community services, hospitals, GPs and care and support.

2.15 To prevent needs emerging across health and care, integrated services should draw on a mixture of qualified health, care and support staff, working collaboratively to deliver prevention. This could involve, for instance, reaching beyond traditional health or care interventions to help people develop or regain the skills of independent living and active involvement in their local community.

Carers and prevention

2.16 Carers play a significant role in preventing the needs for care and support for the people they care for, which is why it is important that local authorities consider preventing carers from developing needs for care and support themselves. There may be specific interventions for carers that prevent, reduce or delay the need for carers' support. These interventions may differ from those for people without caring responsibilities. Examples of services, facilities or resources that could contribute to preventing, delaying or reducing the needs of carers may include but is not limited to those which help carers to:

2.17 As with the people they care for, the duty to prevent carers from developing needs for support is distinct from the duty to meet their eligible needs (see chapter 6). While a person's eligible needs may be met through universal preventative services, this will be an individual response following a needs or carers assessment. Local authorities cannot fulfil their universal prevention duty in relation to carers simply by meeting eligible needs, and nor would universal preventative services always be an appropriate way of for meeting carers' eligible needs.

The focus of prevention

2.18 Local authorities must have regard to promoting wellbeing and the principles set out in chapter 1. Local authorities should look at an individual's life holistically. This will mean considering any care and support needs in the context of the person's skills, ambitions and priorities. This should include consideration of the role a person's family or friends can play in helping the person to meet their goals. This is not creating or adding to their caring role but including them in an approach supporting the person to live as independently as possible for as long as possible. In regard to carers, the local authority should consider how they can be supported to look after their own health and wellbeing and to have a life of their own alongside their caring responsibilities.

2.19 As highlighted in the case study, where people live alone a person may not always have the support from family or friends because they may not live close by. For this group of people prevention needs to be considered through other means, such as the provision of community services and activities that would help support people to maintain an independent life.

Case Study

An older man lives alone with some support from his daughter who works full-time. He needs occasional personal care to remain living independently with dignity, and it is likely that these needs will increase. He has lost contact with family and friends following his wife's death and rarely goes out without support from his daughter who is restricted to taking him out at weekends because of work commitments.

An assessment would consider all of his needs, including those currently being met by his daughter, along with the outcomes he wishes to achieve. A separate carer's assessment offered to his daughter (or a combined assessment if both father and daughter agreed) would establish the daughter's willingness and ability to care and continue to care and how best to promote her own wellbeing, for example by having regard to the outcomes she wishes to achieve. This joint assessment would look at issues such as the possible impact on the daughter of supporting her father while in full-time employment as well as the father's isolation, ability to connect with others or be an active citizen.

Community groups, voluntary organisations, and buddying services could support the father to reduce the social isolation that he may be feeling and maximise opportunities to look after his own health and wellbeing and participate in local community activities. This, in turn could lessen the impact of caring on his daughter and enable her to continue to support her father effectively alongside paid employment. Such support can be identified/suggested alongside other, perhaps more formal services to meet personal care needs, and can be an effective way of promoting wellbeing. In this example, the aspects of wellbeing relating to social wellbeing and family relationships might be promoted.

2.20 In developing and delivering preventative approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services, but are able to design care and support based around achievement of their goals. Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. 'Co-production' is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered. Such interventions can contribute to developing individual resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.

Case Study

Derby City Council used co-production to develop clear and easy to use customer information to support their new customer journey for self-directed support. New information that has been produced includes an assessment form, support planning tools for people using services, customer leaflets and a staff handbook. A small project team held discussions and workshops to identify information that needed improving to be clearer and suggestions for improvement, for example, a new assessment form. Staff working in adult social care assessment teams had training on how to make best use of the new suite of information.

The inclusive approach taken to re-designing the information took longer than an internally managed process, but has resulted in better information, informed people using services and bringing their own perspective and experience. The co-production approach led to the development of key principles which can be used in other areas of communication. The approach is being continued.

2.21 Through the assessment process, an individual will have direct contact with a local authority. A good starting point for a discussion that helps develop resilience and promotes independence would be to ask: 'what does a good life look like for you and your family and how can we work together to achieve it?' Giving people choice and control over the support they may need and access to the right information enables people to stay as well as possible, maintain independence and caring roles for longer.

2.22 Social workers, occupational therapists, other professionals, service providers and commissioners who are effective at preventing, reducing, or delaying needs for care and support are likely to have a holistic picture of the individuals and families receiving support. This will include consideration of a person's strengths and their informal support networks as well as their needs and the risks they face. This approach recognises the value in the resources of voluntary and community groups and the other resources of the local area.

Developing a local approach to preventative support

2.23 A local authority must provide or arrange for services, facilities or resources which would prevent, delay or reduce individuals' needs for care and support, or the needs for support of carers. Local authorities should develop a clear, local approach to prevention which sets out how they plan to fulfill this responsibility, taking into account the different types and focus of preventative support as described above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support.

2.24 Whilst local authorities may choose to provide some types of preventative support themselves, others may be more effectively provided in partnership with other local partners (for example, rehabilitation or falls clinics provided jointly with the local NHS), and further types may be best provided by other organisations (for example, specialist housing providers or some carers' services). A local authority's commissioning strategy for prevention should consider the different commissioning routes available, and the benefits presented by each. This could include connecting to other key areas of local preventative activity outside care, including housing, planning and public health.

2.25 In developing a local approach to prevention, the local authority must take steps to identify and understand both the current and future demand for preventative support, and the supply in terms of services, facilities and other resources available.

2.26 Local authorities must consider the importance of identifying the services, facilities and resources that are already available in their area, which could support people to prevent, reduce or delay needs, and which could form part of the overall local approach to preventative activity. Understanding the breadth of available local resources will help the local authority to consider what gaps may remain, and what further steps it should itself take to promote the market or to put in place its own services.

2.27 Where the local authority does not provide such types of preventative support itself, it should have mechanisms in place for identifying existing and new services, maintaining contact with providers over time, and helping people to access them. Local approaches to prevention should be built on the resources of the local community, including local support networks and facilities provided by other partners and voluntary organisations.

2.28 Local authorities must promote diversity and quality in provision of care and support services, and ensure that a person has a variety of providers to choose from (see chapter 4). Considering the services, facilities and resources which contribute towards preventing or delaying the development of needs for care and support is a core element of fulfilling this responsibility. A local authority should engage local providers of care and support in all aspects of delivery and encourage providers to innovate and respond flexibly to develop interventions that contribute to preventing needs for care and support.

2.29 Local authorities should consider the number of people in its area with existing needs for care and support, as well as those at risk of developing needs in the future, and what can be done to prevent, delay or reduce those needs now and in the future. In doing so, a local authority should draw on existing analyses such as the Joint Strategic Needs Assessment, and work with other local partners such as the NHS and voluntary sector to develop a broader, shared understanding of current and future needs, and support integrated approaches to prevention.

2.30 In particular, local authorities must consider how to identify 'unmet need' - for example, those people with needs which are not currently being met, whether by the local authority or anyone else. Understanding unmet need will be crucial to developing a longer-term approach to prevention that reflects the true needs of the local population. This assessment should also be shared with local partners, such as through the health and wellbeing board, to contribute to wider intelligence for local strategies. Preventative services, facilities or resources are often most effective when brought about through partnerships between different parts of the local authority and between other agencies and the community such as those people who are likely to use and benefit from these services.

2.31 Local authorities should consider how they can work with different partners to identify unmet needs for different groups and coordinate shared approaches to preventing or reducing such needs, for example working with the NHS to identify carers, and working with independent providers including housing providers and the voluntary sector, who can provide local insight into changing or emerging needs beyond eligibility for publically-funded care.

Case Study: Midland Heart's reablement service

At 82, Beryl was diagnosed with stomach cancer and admitted to hospital. As a result of a major operation, she now has a permanent colostomy bag. After only a month Beryl was successfully discharged from hospital to her own home with a reablement package from Leicester City Council and support from the housing association, Midland Heart, to help her regain her independence.

If Beryl had not received this support, she would have been discharged to a more costly care home. The reablement service ensured that Beryl's home was suitably adapted for her return, which allowed a speedy discharge and avoided the need for institutional care. The support service has assisted her attendance at medical appointments with her GP and monitored the impact of her medication.

Working with other partners to focus on prevention

2.32 Developing and delivering local approaches to prevention, the local authority should consider how to align or integrate its approach with that of other local partners. Preventing needs will often be most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.

2.33 Within the local authority, prevention of care and support needs is closely aligned to other local authority responsibilities in relation to public health, children's services, and housing, for example. Across the local landscape, the role of other bodies including the local NHS (for example: GPs, dentists, pharmacists, ophthalmologists), welfare and benefits advisers (for example at Jobcentre Plus), the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach.

2.34 Local authorities must ensure the integration of care and support provision, including prevention with health and health-related services, which include housing (see chapter 15). This responsibility includes in particular a focus on integrating with partners to prevent, reduce or delay needs for care and support.

2.35 A local authority must cooperate with each of its relevant partners and the partners must cooperate with the local authority (see chapter 15 on cooperation and details of specific relevant partners), for example, in relation to the provision of preventative services and the identification of carers, a local authority must cooperate with NHS bodies.

2.36 A local authority must also set up arrangements between its relevant partners and individual departments in relation to its care and support functions, which includes prevention. Relevant partners and individual departments include, but are not limited to, housing departments where, for example, housing services or officers may be well placed to identify people with dementia and their carers, and provide housing related support and/or in partnership with others, home from hospital services or 'step up step down' provision.

Identifying those who may benefit from preventative support

2.37 Local authorities should put in place arrangements to identify and target those individuals who may benefit from particular types of preventative support. Helping people to access such types of support when they need it is likely to have a significant impact on their longer-term health and wellbeing, as well as potentially reducing or delaying the need for ongoing care and support from the local authority.

2.38 In developing such approaches, local authorities should consider the different opportunities for coming into contact with those people who may benefit from preventative support, including where the first contact may be with another professional outside the local authority, for example, GPs, pharmacists or welfare and benefit advisers. There are a number of interactions and access points that could bring a person into contact with the local authority or a partner organisation and act as a trigger point for the local authority to consider whether the provision of a preventative service, or some other step is appropriate. These might include, for example:

2.39 Many people with low level care and support needs will approach the voluntary sector for advice in the first instance. Local authorities and the voluntary sector should work together on how it can share this information to gain a fuller picture of local need as possible. Authorities should bring data from these different sources together to stratify who in the community may need care and support in the future and what types of needs they are likely to have, and use this information to target their preventative services effectively.

2.40 Prevention should be a consistent focus for local authorities in undertaking their care and support functions. However, there may be key points in a person's life or in the care and support process where a preventative intervention may be particularly appropriate or of benefit to the person. Approaches to identifying those people who may benefit from preventative support should consider how to locate people in such circumstances, for example:

2.41 A local authority must establish and maintain a service for providing people with information and advice relating to care and support (see chapter 3). In addition to any more targeted approaches to communicating with individuals who may benefit from preventative support, this service should include information and advice about preventative services, facilities or resources, so that anyone can find out about the types of support available locally that may meet their individual needs and circumstances, and how to access them.

Helping people access preventative support

2.42 A variety of different kinds of service, facilities or resources can be preventative and can help individuals live well and maintain their independence or caring roles for longer.

2.43 Local authorities should be innovative and develop an approach to prevention that meets the needs of their local population. A preventative approach requires a broad range of interventions, as one size will not fit all.

2.44 Where a local authority has put in place mechanisms for identifying people who may benefit from a type of preventative support, it should take steps to ensure that the person concerned understands the need for the particular measure, and is provided with further information and advice as necessary.

2.45 Contact with a person who is identified as being able to benefit from preventative support may lead to the local authority becoming aware that the person appears to have needs for either or both care and support and support in a role as a carer. This appearance of need may trigger the requirement to carry out a needs assessment (in the case of an adult with needs for care and support), or a carer's assessment (see paragraphs 2.48 to 2.54 below). However, where a local authority is not required to carry out such an assessment under the Care Act, it should nonetheless take steps to establish whether the person identified will benefit from the type of preventative support proposed.

2.46 Where a person is provided with any type of service, or support to access any facility or resource as a preventative measure, the local authority should also provide the person with information in relation to the services offered or measure undertaken. The local authority is not required to provide a care and support plan or a support plan where it only takes steps under section 2 of the Care Act; however, it should consider which aspects of a plan should be provided in these circumstances, and should provide such information as is necessary to enable the person to understand:

2.47 The person concerned must agree to the provision of any service or other step proposed by the local authority. Where the person refuses, but continues to appear to have needs for care and support (or for support, in the case of a carer), then the local authority must proceed to offer the individual an assessment.

Assessment of adults' and carers' needs

2.48 In assessing whether an adult has any care and support needs or a carer has any needs for support, the local authority must consider whether the person concerned would benefit from the preventative services, facilities or resources provided by the local authority or which might otherwise be available in the community. This is regardless of whether, in fact, the adult or carer is assessed as having any care and support needs or support needs. As part of the assessment process, the local authority considers the capacity of the person to manage their needs or achieve the outcomes which matter to them, and allows for access to preventative support before a decision is made on whether the person has eligible needs (see chapter 6 on assessment).

2.49 As part of this process, the local authority should also take into account the person's own capabilities, and the potential for improving their skills, as well as the role of any support from family, friends or others that could help them to achieve what they wish for from day-to-day life. This should not assume that others are willing or able to take up caring roles. Where it appears to the local authority that a carer may have needs for support (whether currently or in the future), a carer's assessment must always be offered.

2.50 Children should not undertake inappropriate or excessive caring roles that may have an impact on their development. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing and their prospects in education and life. A local authority may become aware that a child is carrying out a caring role through an assessment or informed through family members or a school. A local authority should consider how supporting the adult with needs for care and support can prevent the young carer from under taking excessive or inappropriate care and support responsibilities. Where a young carer is identified, the local authority must undertake a young carer's assessment under part 3 of the Children Act 1989.

2.51 Considering the support from family, friends or others is important in taking a holistic approach to see the person in the context of their support networks and understanding how their needs may be prevented, reduced or delayed by others within the community, rather than by more formal services (also see chapter 6, paras. 6.65 to 6.71, about the whole family approach to assessment).

2.52 If a person is provided with care and support or support as a carer by the local authority, the authority must provide them with information and advice about what can be done to prevent, delay, or reduce their needs as part of their care and support plan or support plan. This should also include consideration of the person's strengths and the support from other members of the family, friends or the community (see chapter 10 on care and support planning).

2.53 Regardless of whether or not a person is ultimately assessed as having either any needs at all or any needs which are to be met by the local authority, the authority must in any case provide information and advice in an accessible form, about what can be done to prevent, delay, or reduce development of their needs. This is to ensure that all people are provided with targeted, personalised information and advice that can support them to take steps to prevent or reduce their needs, connect more effectively with their local community, and delay the onset of greater needs to maximise their independence and quality of life. Where a person has some needs that are eligible, and also has some other needs that are not deemed to be eligible, the local authority must provide information and advice on services facilities or resources that would contribute to preventing, reducing or delaying the needs which are not eligible, and this should be aligned and be consistent with the care and support plan for the person with care needs, or support plan for the carer.

2.54 It is important that people receive information in a timely manner about the services or interventions that can help or contribute to preventing an escalation in needs for care and support. Supporting people's access to the right information at the right time is a key element of a local authority's responsibilities for prevention.

Charging for preventative support

2.55 Preventative services, like other forms of care and support, are not always provided free, and charging for some services is vital to ensure affordability. The Care and Support (Preventing Needs for Care and Support) Regulations 2014 continue to allow local authorities to make a charge for the provision of certain preventative services, facilities or resources. The regulations also provide that some other specified services must be provided free of charge.

2.56 Prevention services facilities or resources may not involve local authorities directly providing or commissioning a service. Some effective forms of prevention result from partnerships with other public services, voluntary and community organisations and other providers. In developing these partnerships local authorities should consider what obstacles there may be which might prevent people on low incomes from benefitting from the activities and take reasonable steps to avoid this.

2.57 Where a local authority chooses to charge for a particular service, it should consider how to balance the affordability and viability of the activity with the likely impact that charging may have on uptake. In some cases, charging may be necessary in order to make a preventative service viable or keep a service running.

2.58 When charging for any type of preventative support, local authorities should take reasonable steps to ensure that any charge is affordable for the person concerned. This does not need to follow the method of the financial assessment used for mainstream charging purposes; and the use of such a process is likely to be disproportionate.

2.59 However, local authorities should consider adopting a more proportionate or 'light-touch' approach which ensures that charges are only paid by those who can afford to do so. In any event, a local authority must not charge more than it costs to provide or arrange for the service, facility or resource.

2.60 The regulations require that intermediate care and reablement must be provided free of charge for up to 6 weeks, as must aids and minor adaptations (for example: adaptations up to the value of £1,000) (see also 8.14).

2.61 Where local authorities provide intermediate care or reablement to those who require it, this must be provided free of charge for a period of up to 6 weeks. This is for all adults, irrespective of whether they have eligible needs for ongoing care and support. Although such types of support will usually be provided as a preventative measure under section 2 of the Act, they may also be provided as part of a package of care and support to meet eligible needs. In these cases, regulations also provide that intermediate care or reablement cannot be charged for in the first 6 weeks, to ensure consistency.

2.62 Whilst they are both time-limited interventions, neither intermediate care nor reablement should have a strict time limit, since the period of time for which the support is provided should depend on the needs and outcomes of the individual. In some cases, for instance a period of rehabilitation for a visually impaired person (a specific form of reablement) , may be expected to last longer than 6 weeks. Whilst the local authority does have the power to charge for this where it is provided beyond 6 weeks, local authorities should consider continuing to provide it free of charge beyond 6 weeks in view of the clear preventative benefits to the individual and, in many cases, the reduced risk of hospital admissions.

2.63 Local authorities should consider the potential impact and consequences of ending the provision of preventative services. Poorly considered exit strategies can negate the positive outcomes of preventative services, facilities or resources, and ongoing low-level care and support can have significant impact on preventing, reducing and delaying need.

Case Study

Mr A is a 91 year old man who lives alone with his dog in his house. He is usually independent, is a passionate cook and enjoys socialising. He drives a car. Whilst out walking his dog he suffered a stroke, he fell, causing a fractured neck of femur. He was admitted to hospital and underwent surgery for a hip replacement which meant he had to follow hip precautions for 6 weeks.

Mr A was discharged, independently mobile using a frame, independent transferring using equipment and stair climbing with supervision. He was discharged home with 4 calls per day from BEST plus (Bradford Enablement Support Team). Joint sessions between the PTs and OTs and BEST plus were completed to work on the following:

The above goals were achieved and new goals were set in consultation with Mr A:

After 6 weeks of continued BEST plus input in Mr A's home, he was able to achieve all of his goals and all Social Services input was withdrawn. Aspects of Mr A's wellbeing have been promoted including physical wellbeing, social wellbeing, and control over day-to-day life.

3. Information and advice

This chapter provides guidance on section 4 of the Care Act 2014 and covers:

3.1 Information and advice is fundamental to enabling people, carers and families to take control of, and make well-informed choices about, their care and support and how they fund it. Not only does information and advice help to promote people's wellbeing by increasing their ability to exercise choice and control, it is also a vital component of preventing or delaying people's need for care and support.

3.2 Local authorities 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'.

3.3 The local authority has an active and critical role in the provision of information and advice and must take an active role. To fulfil its duty under section 4 of the Act, a local authority is likely to need to go further than providing information and advice directly (though direct provision will be important) by working to ensure the coherence, sufficiency, availability and accessibility of information and advice relating to care and support across the local authority area. Importantly, this duty to establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system.

3.4 It is important to be clear that the duty to establish and maintain an information and advice service is distinct from the duty to meet eligible needs (see chapter 6): this is true for both people with care and support needs and their carers. While a person's eligible needs may be met by the provision of information and advice this will be an individual response following a needs or carers assessment. Local authorities cannot fulfil their universal information and advice duty simply by meeting eligible needs, and nor would information and advice always be an appropriate way of meeting eligible needs.

3.5 The local authority must ensure that information and advice services established cover more than just basic information about care and support and cover the wide range of care and support related areas set out in para. 3.22. The service should also address, prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required. In fulfilling this duty, local authorities should consider the people they are communicating with on a case by case basis, and seek to actively encourage them towards the types of information and/or advice that may be particularly relevant to them.

3.6 Local authorities must also have regard to identifying people that contact them who may benefit from financial information and advice independent of the local authority and actively facilitate those people to access to it (see paragraph 3.50). Separately to the duty to establish and maintain an information and advice service, local authorities must provide independent advocacy to facilitate the person's involvement in the care and support assessment, planning and review processes where an individual would experience substantial difficulty in understanding, retaining or using information given, or in communicating their views, wishes or feelings and where there is nobody else appropriate (see chapter 7).

3.7 The availability and provision of information and advice, whether more general information about the way the system operates in the local authority area or more personalised information on a person's specific needs, are essential building blocks to all of the reforms and many of the specific duties the Act introduces. This chapter of guidance should therefore be read in conjunction with guidance throughout this document, including:

promoting individual wellbeing (chapter 1)

prevention of needs for care and support (chapter 2)

integration of care and support with health and housing related services (chapter 15)

promoting diverse and high quality services (chapter 4)

assessment and eligibility (chapter 6)

personal budgets, personal care and support planning and direct payments (chapters 10 to 13)

deferred payment agreements (chapter 9)

continuity of care (chapter 20)

safeguarding (chapter 14)

transition to adult care and support (chapter 16)

independent advocacy (chapter 7)

Terminology

3.8 In this section of guidance, the term 'information' means the communication of knowledge and facts regarding care and support. 'Advice' means helping a person to identify choices and/or providing an opinion or recommendation regarding a course of action in relation to care and support.

3.9 This section of guidance also uses the term 'advocacy' to mean 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.

3.10 This guidance talks about 'financial information and advice' which includes a broad spectrum of services whose purpose is to help people plan, prepare and pay for their care costs. In places it talks of 'independent' financial information or advice which in this document means services independent of the local authority. This guidance also refers to 'regulated' financial advice which means advice from an organisation regulated by the Financial Conduct Authority ( FCA) which can extend to individual recommendations about specific financial products. Local authorities should ensure that people are able to access all of these types of financial information and advice which help people plan and pay for their care.

The duty to establish and maintain a service

3.11 Local authorities must establish and maintain a service for providing people in their areas with information and advice relating to care and support for adults and support for carers. In doing so local authorities should take account of the services currently in place and actions already taken and plans with partner organisations resulting from Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. The information and advice service must cover the needs of all its population, not just those who are in receipt of local authority funded care or support. For example, people may often require information and advice before they need to access care or support services, to consider what actions they may take now to prevent or delay any need for care, or how they might plan to meet the cost of future care needs.

3.12 People need information and advice across many areas to support them to make informed choices about their care and support (see para. 3.23).

3.13 In establishing and maintaining an information and advice service, local authorities should ensure that they engage widely with people with care and support needs, carers, the wider public and local providers of information and advice and other types of care and support, to identify what is available and exactly what is needed locally, and how and where information and advice should best be provided.

3.14 It is important to recognise that while local authorities must establish and maintain a service, the duty does not require they provide all elements of this service. Rather, under this duty local authorities are expected to understand, co-ordinate and make effective use of other high quality statutory, voluntary and/or private sector information and advice resources available to people within their areas. This may also include provision of a service or parts of a service in conjunction with one or more local authorities, health services, children's services, or reuse of information from other local or national sources. When a local need for additional information and advice services is identified, local authorities should recognise the relevance of independent and impartial advice and should consider carefully whether services should be provided by the local authority directly or by another agency, including independent providers.

The audiences for the information and advice service

3.15 Local authorities are responsible for ensuring that all adults including carers in their area with a need for information and advice about care and support are able to access it. This is a very broad group, extending much further than people who have an immediate need for care or support. It will only be achieved through working in partnership with the wider public and local advice and information providers.

3.16 People (carers included) who are likely to need information and advice include, but are not restricted to:

people wanting to plan for their future care and support needs

people who may develop care and support needs, or whose current care and support needs may become greater. Under the duty of prevention in Section 2 of the Act, local authorities are expected to take action to prevent, delay and/or reduce the care and support needs for these people (see chapter 2 on prevention)

people who have not presented to local authorities for assessment but are likely to be in need of care and support. Local authorities are expected to take steps to identify such people and encourage them to come forward for an assessment of their needs (see chapter 2 on prevention)

people who become known to the local authority (through referral, including self-referral), at first contact where an assessment of needs is being considered (see chapter 6 on assessments)

people who are assessed by local authorities as currently being in need of care and support. Advice and information must be offered to these people irrespective of whether they have been assessed as having eligible needs which the local authority must meet (see chapter 6 on assessments)

people whose eligible needs for care and support the local authority is currently meeting (whether the local authority is paying for some, all or none of the costs of meeting those needs) (see chapter 10 on care and support planning)

people whose care and support or support plans are being reviewed (see chapter 13 on reviews of care and support plans)

family members and carers of adults with care and support needs, (or those who are likely to develop care and support needs). Under Sections 2 of the Act, local authorities are expected to have regard to the importance of identifying carers and take action to reduce their needs for support (see chapter 6 on assessments)

adults who are subject to adult safeguarding concerns (see chapter 14 on safeguarding)

people who may benefit from financial information and advice on matters concerning care and support. Local authorities must have regard to the importance of identifying these people, to help them understand the financial costs of their care and support and access independent financial information and advice including from regulated financial advisers (see para. 3.49)

care and support staff who have contact with and provide information and advice as part of their jobs

3.17 In providing information and advice, local authorities must recognise and respond to the specific requirements that carers have for both general and personal information and advice. A carer's need for information and advice may be separate and distinct from information and advice for the person they are caring for. These distinct needs may be covered together, in a similar manner to the local authority combining an assessment of a person needing care and support with a carer's assessment (where both the individuals concerned agree) (see chapter 6 on assessments), but may be more appropriately addressed separately. This may include information and advice on:

Access to and quality of information and advice

3.18 The local authority must ensure that there is an accessible information and advice service that meets the needs of its population. Information and advice must be open to everyone who would benefit from it. People access information and advice from a wide variety of sources. The authority should take account of information standards published by the Information Standards Board for Health and Social Care under the provisions of the Health and Social Care Act 2012.

3.19 Local authorities should ensure that information supplied is clear. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. Local authorities will need to take steps to evaluate and ensure that information and advice is understood and able to be acted upon.

3.20 Information and advice provided within the service should be accurate, up-to-date and consistent with other sources of information and advice. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained.

3.21 All reasonable efforts should be taken to ensure that information and advice provided meets the individual's requirements, is comprehensive and is given at an early stage. Local authorities must seek to ensure that all relevant information is available to people for them to make the best informed decision in their particular circumstances, and omission or the withholding of information would be at odds with the duty as set out in the Act.

3.22 There are some circumstances where it is particularly important for information and advice to be impartially provided. Local authorities should consider when this might most effectively be provided by an independent source rather than by the local authority itself. This is particularly likely to be the case when people need advice about how and whether to question or challenge the decisions of the local authority or other statutory body.

What should be provided - information and advice content

3.23 In discharging this duty, local authorities must ensure that information and advice is provided on:

3.24 The breadth of the circumstances under which information and advice must be provided, and the overall duty to promote individual wellbeing, means that local authorities must ensure that the subject matters covered by their information and advice available to people in their areas go much further than a narrow definition of care and support and cover all those subject matters listed in paragraph 3.23 above. Depending on local circumstances, the service should also include, but not be limited to, information and advice on:

available housing and housing-related support options for those with care and support needs

effective treatment and support for health conditions, including Continuing Health Care arrangements

availability and quality of health services

availability of services that may help people remain independent for longer such as home improvement agencies, handyman or maintenance services

availability of befriending services and other services to prevent social isolation

availability of intermediate care entitlements such as aids and adaptations

eligibility and applying for disability benefits and other types of benefits

availability of employment support for disabled adults

children's social care services and transition

availability of carers' services and benefits

sources of independent information, advice and advocacy

the Court of Protection, power of attorney and becoming a deputy

raise awareness of the need to plan for future care costs

practical help with planning to meet future or current care costs

accessible ways and support to help people understand the different types of abuse and its prevention

When information should be provided

3.25 Local authorities have a number of direct opportunities to provide - or signpost to - advice and information when people in need of care and support come into contact with them. These include:

at first point of contact with the local authority

as part of a needs or carer's assessment, including joint continuing healthcare assessments

during a period of reablement

around and following financial assessment

when considering a financial commitment such as a deferred payment agreement or top-up agreement

during or following an adult safeguarding enquiry

when considering take up of a personal budget and/or direct payment

during the care and support planning process

during the review of a person's care and support plan

when a person may be considering a move to another local authority area

at points in transition, for example when people needing care or carers under 18 become adults and the systems for support may change

3.26 Local authorities, working with their partners must use the wider opportunities to provide targeted information and advice at key points in people's contact with the care and support, health and other local services. These include, but are not limited to, known 'trigger points' during a person's life such as:

contact with other local authority services

bereavement

hospital entry and/or discharge

diagnosis of health conditions - such as dementia, stroke or an acquired impairment for example

consideration or review of continuing healthcare arrangements

take-up of power of attorney

applications to Court of Protection

application for, or review of, disability benefits such as attendance allowance

personal independence payments, and for carers allowance

access to work interviews

contact with local support groups, charities, or user-led organisations including carers

groups and disabled person's organisations

contact with or use of private care and support services, including homes care

change or loss of housing

contact with the criminal justice system

admission to or release from prison

'Guidance Guarantee' in the Pensions Act 2014

retirement

Accessibility of information and advice

3.27 The local authority should ensure that products and materials (in all formats) are as accessible as possible for all potential users. Websites should meet specific standards such as the Web Content Accessibility Guidelines and guidance set out in the Government Digital Service's ( GDS) service manual, printed products should be produced to appropriate guidelines with important materials available in easy read, and telephone services should also be available to those with hearing impairments. Local authorities should particularly be aware of the needs of individuals with complex but relatively rare conditions, such as deaf-blindness.

3.28 As required under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in accessible formats or with communication support.

3.29 Advice and information content should, where possible, be provided in the manner preferred by the person and will therefore often need to be available in a number of different formats. The duty in the Care Act will not be met through the use of digital channels alone, and information and advice channels are likely to include all of the following:

3.30 Some groups in need of information and advice about care and support may have particular requirements. Local authorities must ensure that their information and advice service has due regard to the needs of these people. These include, but are not limited to:

3.31 Some people, including some people with dementia, may benefit from an independent person to help them to access or avail themselves of necessary information and advice. Any such need for help to facilitate access to this universal information and advice needs to be considered in planning for delivery of the service, although the duty to make arrangements for an individual to have an independent advocate available to them in certain circumstances only applies in relation to an individual's involvement in the assessment, planning and review processes. From the point of first contact with or referral to the authority consideration of the duty to provide for independent advocacy to support involvement in assessment, planning and reviews should be undertaken (see chapter 7 on independent advocacy).

Proportionality of information and advice

3.32 The type, extent and timing of information and advice provided should be appropriate to the needs of the person. More complex issues may require more intensive and more personalised information and advice, helping people to understand the choices available to them, while general enquiries may require a less intensive approach. It is also important that the right level of information and advice is provided at the right time, recognising that a person's need for information or advice may vary depending on the circumstance. For example, providing a person with too much information, more than they can take in, perhaps at a time of crisis, can be counter-productive.

3.33 There are clear messages from past public consultations and from research that people 'don't know what they need to know' in relation to their care and support. This can prevent them asking the right questions and can mask the articulation and identification of needs that they have, for which they could benefit from information and advice. All contact for information and advice should take account of this and be able to respond with an assessment of needs when appropriate (see chapter 6).

3.34 Local authorities should help ensure that information and advice is proportionate to the needs of those for whom it is provided. This could include enabling access to the support of registered social work advice for those providing information and advice to people contacting the local authority. This can help ensure that the potential for complexity is recognised early on and the person receives help to access non-statutory services and/or initial statutory sector support proportionate to their needs.

3.35 In providing an information and advice service, local authorities must be providing more than just leaflets and web-based materials. The focus should be on enabling people to access what they need through a tailored range of services that assists people to navigate all points and aspects of their journey through care and support. In doing this, local authorities should think about how they are reaching out and joining up with other providers of information and advice to ensure the coherence of the overall 'offer' (see chapter 15 on integration and cooperation).

Financial information and advice

3.36 Financial information and advice is fundamental to enabling people to make well-informed choices about how they pay for their care. It is integral to a person's consideration of how best to meet care and support needs, immediately or in the future. People with good and impartial financial information and advice have a better understanding of how their available resources can be used more flexibly to fund a wider range of care options.

3.37 Financial information and advice is considered in a separate section due to the sometimes specialist and complex nature of what can be needed. This section should be read in the context of the overarching chapter and all requirements set out in this chapter, for example on accessibility and proportionality, must also be applied to financial information and advice. As set out at the start of the chapter, when this section refers to 'independent financial information and advice' it means services independent of the local authority. Where it refers to 'regulated' financial advice it means advice from an organisation regulated by the FCA which can extend to individual recommendations about specific financial products.

3.38 The service that local authorities are required to establish and maintain must include financial information and advice on matters relevant to care and support. It should provide some of this information directly to people in its community. However, where it would not be appropriate for a local authority to provide it directly, the local authority must ensure that people are helped to understand how to access independent financial advice.

3.39 Care decisions are often made quickly and at a time of crisis, and they can often involve family and friends in the process. The local authority must have regard to the importance of identifying those who may benefit from financial advice or information as early as possible. This should be complemented by broader awareness raising about how care and support is funded. Local authorities may also include how care and support costs interact with retirement decisions. Actions taken by a local authority to do this should include:

3.40 When making financial plans about how to pay for care and support, a person needs to have confidence in what to do in the present, a view ahead to the future and a plan for what to do if circumstances change. This long-term outlook means that people will want to access financial information and advice at different points in their journey to enable them to make sustainable plans to pay for their care. The local authority should provide a service that covers this breadth and that facilitates access to the full spectrum of financial information and advice - from basic budgeting tips to regulated advice - to ensure that people within its area who would benefit can access it. They should also be aware and provide for the fact that some people will be less able to protect themselves from theft, fraud and financial exploitations (see chapter 14 on safeguarding).

3.41 The local authority service should include the following aspects of financial information and advice:

3.42 Before providing financial information or advice directly to a person the local authority should establish whether the person has a deputy of the Court of Protection or a person with Lasting Power of Attorney acting on their behalf.

Understanding care charges

3.43 The local authority must provide information to help people understand what they may have to pay, when and why and how it relates to people's individual circumstances. This must include the charging framework for care and support, how contributions are calculated (from both assets and income) and the means tested support available; top-ups (see chapter 8 on charging); and how care and support choices may affect costs. In the case of top-ups, the local authority should ensure that someone is willing and able to pay for them - this information will be fundamental in helping with this. The local authority should use the knowledge it has of the local care market - types of care and local providers of information and advice - to complement and develop the overarching narrative on how care funding works at the national level. This would include both domiciliary and residential care.

Ways to pay

3.44 The local authority must provide people with information on the availability of different ways to pay for care including through income and assets (for example, pension or housing wealth), a deferred payment agreement (see chapter 9 on deferred payment agreements), a financial product or a combination of these things. Local authorities should seek to give information that would be particularly pertinent to a person's individual circumstances and facilitate access to an independent source of information or advice where relevant. This will be of particular relevance where a person will be meeting the total cost of care and support themselves or may be considering taking out a deferred payment agreement (see chapter 9 on deferred payments) or purchasing a financial product.

Money management

3.45 Different people will need different levels of support from the local authority and other providers of information and advice depending on their financial capability, their care needs and the amount they are expected to contribute. At the lower end of the spectrum, people may just need some basic information and support to help them rebalance their finances in light of their changing circumstances. Topics may include welfare benefits, advice on good money management, help with basic budgeting and possibly on debt management. The local authority may be able to provide some of this information itself, for example on welfare benefits, but where it cannot, it should help people access it.

Making informed financial decisions

3.46 The local authority must support people to make informed, affordable and sustainable financial decisions about their care throughout all stages of their life. In many situations the role of the local authority will be to understand the circumstances of the person, understand their preferences and help them to access the tailored information and advice that they need to make well-informed decisions. Where a person lacks capacity, the authority must establish whether a person has a deputy of the Court of Protection or a person with Lasting Power of Attorney acting on their behalf.

3.47 The local authority must offer to consider a person's specific circumstances and provide them with information about the methods of paying for their care and support that may be available to them. The local authority may consider the timing and context of any retirement decisions a person might be making and how this interacts with paying for their care and support. They should advise people of the ways to pay that others in similar circumstances would usually consider and the range of information and advice they should be considering to help make their decision.

3.48 To help people access the information and advice they need, the local authority should have a clear view of the information and advice services available locally and what they provide. The local authority should take a role in joining up information and advice organisations locally so they can work collaboratively. The local authority should help information and advice providers and people to understand the role of each information and advice provider so people can access the right provider at the right time and not be sent round in circles. Local authorities should provide and publicise links and information on access to wider sources of information and advice, including those available nationally.

3.49 Local authorities should ensure that staff, including front line staff, are able to support people to access the information and advice they need to make good financial decisions. Staff should have the knowledge to direct people to the financial information and advice they need, explaining the differences and potential benefits from seeking regulated or non-regulated financial advice.

Facilitating access to independent financial information and advice

3.50 A key role for local authorities, when it would be inappropriate to provide it itself, is to facilitate access to financial information and advice which is impartial and independent of a local authority. This should include both generic free and fee-based advice as well as services providing regulated forms of financial advice. 'Facilitating access' may include making people aware of specific sources of information and advice that are available and giving information about how to use them. Local authorities should make people aware which independent services may charge for the information and advice they provide. Local authorities should be able to actively describe the general benefits of independent information and advice and, based on what is known of an individual's circumstance, be able to explain the reasons why it may be beneficial for a person to take independent financial advice.

3.51 Where a person may be considering taking regulated financial advice local authorities are not required or encouraged to make a direct referral to one individual independent financial adviser, but they should actively help and direct a person to a choice of advisers regulated by the Financial Conduct Authority with the appropriate qualifications and accreditation. The local authority should ensure that they do this on a transparent basis.

3.52 Further practice guidance is also available to support local authorities to facilitate access to independent financial information and advice.

Information and advice on adult safeguarding

3.53 The government expects local authorities and others to help people with care and support needs, who may be at risk of abuse or neglect as a result of those needs, keep safe. But this must not mean preventing them making their own choices and having control over their lives. Everyone in the community should understand the importance of safeguarding and help keep people safe (see chapter 14 on safeguarding).

3.54 The local authority must provide information and advice on how to raise concerns about the safety or wellbeing of an adult who has needs for care and support and should support public knowledge and awareness of different types of abuse and neglect, how to keep yourself physically, sexually, financially and emotionally safe, and how to support people to keep safe. The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on how the local Safeguarding Adults Board works.

Complaints

3.55 Current complaints provision in relation to local authority social services is set out in regulations. The provisions of the regulations mean that anyone who is dissatisfied with a decision made by the local authority would be able to make a complaint about that decision and have that complaint handled by the local authority. The local authority must make its own arrangements for dealing with complaints in accordance with the 2009 regulations. As an essential part of how the whole system operates, under the 2009 regulations the local authority's arrangements must ensure that those who make complaints receive, as far as reasonably practicable, assistance to enable them to understand the complaints procedure or advice on where to obtain such assistance.

Reviewing and developing a plan or strategy

3.56 Local differences and different starting points will mean that each local authority will need to develop and implement a plan regarding their information and advice services that matches their circumstances and meets the needs of its population. The information and advice service should be aligned with wider local authority strategies such as market shaping and commissioning, and with joint area strategies with health. The development of such plans should have regard to some common principles, including:

involving people who use services and carers, interested organisations and service providers in determining what is needed and how it is provided

being available at the right time for people who need it, in a range of accessible formats and through a range of channels

meeting the needs of all groups

being clear, comprehensive and impartial

be consistent, accurate and up-to-date

meeting quality standards, such as the Advice Quality Standard

being based on a detailed analysis of the needs of the local population served by the local authority

being commissioned in tandem with other relevant support and independent advocacy services

avoiding unnecessary duplication

directing people to sources of further information

be used to inform future planning

ensuring appropriate quality assurance and review, including customer feedback to make sure that the service learns from experience and continuously improves

3.57 The plan should build on local and national best practice and make best use of national resources. These national resources include guidance on principles for local information and advice strategies, case studies and practice examples.

3.58 The local authority must exercise its functions under the Care Act, including the duty to provide an information and advice service, with a view to integrating care and support provision with health and health-related issues (including housing). It must also co-operate more generally with each of its relevant partners taking account of their respective functions (see chapter 15 on integration, cooperation and partnerships). The Local Government and Public Involvement in Health Act 2007 (as amended by the Health and Social Care Act 2012), provides that local authorities are under a duty to work with their local CCGs, and other partners through the Health and Wellbeing Board to undertake Joint Strategic Needs Assessments for their areas and to develop Joint Health and Wellbeing Strategies. Statutory Guidance published in March 2013 makes clear that the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategies must be published, and have specific regard to 'what health and social care information the community needs, including how they access it and what support they may need to understand it'.

3.59 The development and implementation of a wider plan or strategy on the provision of information and advice on care and support should be led by the local authority, acting as the coordinator and where appropriate the commissioners of information and advice services.

3.60 The development of information and advice plans and their implementation should be an ongoing and dynamic process, involving all relevant stakeholders, rather than a one off occurrence. The plan and the resulting service should adapt to changing needs and as a result of feedback and learning on what works best. The plan should be reviewed at agreed intervals. As a minimum, the process of developing a local plan should include:

engagement with people, carers and family members, to understand what is working and not working for them, their preferences and how their information advice and advocacy needs can best be met

adopting a 'co-production' approach to their plan, involving user groups and people themselves, other appropriate statutory, commercial and voluntary sector service providers, and make public the plan once finalised

mapping to understand the range of information, advice and advocacy services, including independent financial advice and different providers available

coordination with other statutory bodies with an interest in care and support, including local CCGs, Health and Wellbeing Boards, local Healthwatch and neighbouring local authorities

building into the plan opportunities to record, measure and assess the impact of information and advice services rather than simply service outputs

3.61 In deciding the types of information and advice services to be provided, each local authority will need to analyse and understand the specific needs of its population. Some of the factors and circumstances that local authorities should consider in doing this will often be identified in Joint Strategic Needs Assessments. These factors may include, but are not limited to:

3.62 Local authorities should review and publish information about the effectiveness of the information and advice service locally, including customer satisfaction and may wish to build these into the local Joint Health and Wellbeing Strategies.

3.63 These actions will support local authorities to meet their duties for understanding and promoting the efficient and effective market of services for meeting care and support needs in its area (see chapter 4).

3.64 As part of their plans, local authorities should consider the persons and/or places most likely to come into contact with people in need of information and advice at these and other critical points in the person's care and support journey. This may be another statutory party, such as a GP or other NHS professional, other professionals, such as a solicitor or funeral director, care and support and housing providers, or a local group, user-led or charitable organisation, rather than the local authority itself. Local authorities should consider whether independent sources of information and advice may in some circumstances be more trusted - and therefore more effective - than the local authority itself (see chapter 15, para. 15.71) .

3.65 In addition or instead of direct provision, local authorities should consider whether it is in a person's best interests that they be signposted, directed or referred to independent sources of information and advice. In particular, people should be signposted to appropriate independent information and advice when they are entering into a legal agreement with a local authority or other third party, such as a deferred payment agreement or committing to a top-up, or they wish to question, challenge or appeal a decision of the local authority or other statutory body.

3.66 People often come into contact with care and support services and need to make important decisions at a time of crisis. A local authority plan should therefore allow for the urgent provision of information and advice when necessary. Local authorities should work with health organisations and other partners to provide targeted information and advice to people in these critical situations and where people have long-term health conditions such as dementia (see paragraph 3.26).

3.67 In their information and advice planning, local authorities will need to weigh up the likely demand and effectiveness of these different channels of communication, some of which will incur substantially higher costs than others. A plan that relies disproportionately on provision of information and advice through the authority's website, or third party websites, is unlikely to meet the authority's duty under the Act to establish and maintain a service to provide information and advice on care and support.

3.68 Local authorities will need to consider in their information and advice planning the appropriate interface and balance between local and national sources of information and advice. Where appropriate, local authorities should signpost or refer people to national sources of information and advice where these are recognised as the most useful source. Examples might include:

the NHS Choices website which contains a mix of textual content, videos, and tools such as the online quality profiles of registered care providers in local areas. Local authorities are encouraged to add local sources of information and advice to the online profiles and make sure their local registered care providers add information on the services and support they offer.

NHS Choices website. Health A to Z, detailed information on specific health conditions and how/where to access health services

Carers Direct - national telephone helpline: Telephone 0300 123 1053

Money Advice Service

the Care Quality Commission

the Local Government Ombudsman

consumer websites providing people with information and advice, including on managing their finances well, for example Which? Elderly Care

national charities and/or advice services supporting people with disabilities or older people and those with expert knowledge of specific conditions (for example, deaf blind). For example, Age UK ; Independent Age; Alzheimer's Society and Sense, and their national telephone advice/help lines

national charities and advice services for carers, for example Carers UK or Age UK

national resources related to housing, accommodation and housing related support, for example FirstStop Advice or Foundations

3.69 Some national providers, for example the Money Advice Service and NHS Choices, may also offer free access to tools, resources and information content that can be integrated into local authority websites or delivered in paper formats. Local authorities are encouraged to explore how they can make the most of cost-effective partnership opportunities with national providers. Referral or signposting to national sources should only occur where this is deemed to be in the best interests of the person and their circumstances and should not take the place of local services necessary for local authorities to discharge their duty under the Act. Local authorities will need to find the appropriate balance between local and national provision to cost-effectively meet their local need.

3.70 Information and advice, whether provided directly by a local authority or by third parties as part of the information and advice service that the local authority establishes and maintains, should be of a good standard and, where appropriate, delivered by trained or suitably qualified individuals.

4. Market shaping and commissioning of adult care and support

This chapter provides guidance on section 5 of the Care Act 2014 and covers:

the principles which should underpin market-shaping and commissioning activity:

focusing on outcomes and wellbeing

promoting quality services, including through workforce development and remuneration and ensuring appropriately resourced care and support

supporting sustainability

ensuring choice

co-production with partners

the steps which local authorities should take to develop and implement local approaches to market-shaping and commissioning:

designing strategies that meet local needs

engaging with providers and local communities

understanding the market

facilitating the development of the market

integrating their approach with local partners

securing supply in the market and assuring its quality through contracting

4.1 High-quality, personalised care and support can only be achieved where there is a vibrant, responsive market of service providers. The role of the local authority is critical to achieving this, both through the actions it takes to commission services directly to meet needs and the broader understanding of and interactions it undertakes with, the wider market, for the benefit of all local people and communities.

4.2 The Care Act places new duties on local authorities to promote the efficient and effective operation of the market for adult care and support as a whole. This can be considered a duty to facilitate the market, in the sense of using a wide range of approaches to encourage and shape it, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost-effective outcomes that promote the wellbeing of people who need care and support.

4.3 The market for care and support services is part of a wider system in which much of the need for care and support is met by people's own efforts, by their families, friends or other carers, and by community networks. Local authorities have a vital role in ensuring that universal services are available to the whole population and where necessary, tailored to meet the needs of those with additional support requirements (for example housing and leisure services). Market shaping and commissioning should aim to promote a market for care and support that should be seen as broadening, supplementing and supporting all these vital sources of care and support.

4.4 Local authorities should review the way they commission services, as this is a prime way to achieve effective market shaping and directly affects services for those whose needs are met by the local authority, including where funded wholly or partly by the state.

4.5 At a time of increasing pressure on public funds, changing patterns of needs, and increasing aspirations of citizens, together with momentum for integrated services, joint commissioning, and choice for individuals, it is suggested that fundamental changes to the way care and support services are arranged may be needed, driven through a transformation of the way services are led, considered and arranged (PDF, 1.18MB). Commissioning and market shaping are key levers for local authorities in designing and facilitating a healthy market of quality services.

Definitions

4.6 Market shaping means the local authority collaborating closely with other relevant partners, including people with care and support needs, carers and families, to encourage and facilitate the whole market in its area for care, support and related services. This includes services arranged and paid for by the state through the authority itself, those services paid by the state through direct payments, and those services arranged and paid for by individuals from whatever sources (sometimes called 'self-funders'), and services paid for by a combination of these sources. Market shaping activity should stimulate a diverse range of appropriate high quality services (both in terms of the types of services and the types of provider organisation), and ensure the market as a whole remains vibrant and sustainable.

4.7 The core activities of market shaping are to engage with stakeholders to develop understanding of supply and demand and articulate likely trends that reflect people's evolving needs and aspirations, and based on evidence, to signal to the market the types of services needed now and in the future to meet them, encourage innovation, investment and continuous improvement. It also includes working to ensure that those who purchase their own services are empowered to be effective consumers, for example by helping people who want to take direct payments make informed decisions about employing personal assistants. A local authority's own commissioning practices are likely to have a significant influence on the market to achieve the desired outcomes, but other interventions may be needed, for example, incentivising innovation by user-led or third sector providers, possibly through grant funding.

4.8 Commissioning is the local authority's cyclical activity to assess the needs of its local population for care and support services, determining what element of this needs to be arranged by the authority, then designing, delivering, monitoring and evaluating those services to ensure appropriate outcomes. From the 1990s onwards care services have been increasingly procured from the independent sector (for example, not directly commissioned from and provided by an authority itself) and covered all services that the authority arranged for people receiving state funding. Since 2007 when personalisation became a mainstream policy, commissioning has also covered activity to ensure that sufficient and appropriate services are available to meet the needs of growing numbers of people with personal budgets and direct payments. This has changed the commissioning role, as purchasing decisions have been increasingly devolved to individuals and families and direct procurement using block contracts has reduced. Commissioning has come to be shaped more by the outcomes commissioners and individuals identify, rather than volumes of activity expected and commissioners have sought to facilitate flexible arrangements with providers for other forms of service to support choice and control, such as Individual Service Funds ( ISFs).

4.9 Procurement is the specific functions carried out by the local authority to buy or acquire the services which the local authority has a duty to arrange to meet people's needs, to agreed quality standards so as to provide effective value for money to the public purse and deliver its commissioning strategy.

4.10 Contracting is the means by which that process is made legally binding. Contract management is the process that then ensures that the services continue to be delivered to the agreed quality standards. Commissioning encompasses procurement but includes the wider set of strategic activities.

4.11 This statutory guidance describes, at a high level, the themes and issues that local authorities should have regard to when carrying out duties to shape their local markets and commission services. Market shaping, commissioning, procurement and contracting are inter-related activities and the themes of this guidance will apply to each to a greater or lesser extent depending on the specific activity.

Principles of market-shaping and commissioning

Focusing on outcomes

4.12 Local authorities must ensure that the promotion of the wellbeing of individuals who need care and support, and the wellbeing of carers, and the outcomes they require, are central to all care and support functions in relation to individuals, emphasising the importance of enabling people to stay independent for as long as possible.

4.13 Local authorities will need to understand the outcomes which matter most to people in their area, and demonstrate that these outcomes are at the heart of their local strategies and approaches.

4.14 Local authorities should consider the Adult Social Care Outcomes Framework ( ASCOF), in addition to any locally-collected information on outcomes and experiences (for example, from local consumer research), when framing outcomes for their locality and groups of people with care and support needs. Local authorities should have regard to guidance from the Think Local Act Personal ( TLAP) partnership when framing outcomes for individuals, groups and their local population, in particular the Making It Real 'I' statements, which set out what good personalised care and support should look like from the perspective of people with care and support needs, carers and family members. Outcomes should be considered both in terms of outcomes for individuals and outcomes for groups of people and populations. Local authorities should consider the emerging revised Care Quality Commission standards for quality and any emerging national frameworks for defining outcomes. Local authorities may find the Chartered Institute of Housing's Service Quality Tool for housing-related services useful. This builds on and updates the Quality Assessment Framework ( QAF).

4.15 Local authorities should consider analysing and presenting local needs for services in terms of outcomes required. Local authorities should ensure that achieving better outcomes is central to its commissioning strategy and practices, and should be able to demonstrate that they are moving to contracting in a way that has an outcome basis at its heart. Local authorities should consider emerging best practice on outcomes-based commissioning.

4.16 Outcomes-based services mean developing service arrangements that are defined on the basis of an agreed set of outcomes either for an individual or a group of people. Moving to an outcomes-based approach therefore means changing the way services are bought: from units of provision to meet a specified need (for example, hours of care provided) to what is required to ensure specified measurable outcomes for people are met. The approach should emphasise prevention, enablement, ways of reducing loneliness and social isolation and promotion of independence as ways of achieving and exceeding desired outcomes, as well as choice in how people's needs are met. Moving to an outcomes-based approach will need to recognise that some outcomes are challenging to assess and local authorities may wish to consider involving service providers when considering how service evaluations can be interpreted. Outcomes should be used as a principal measure for quality assurance of services.

4.17 In encouraging outcomes-based services, consideration should be given to how services are paid for. Local authorities should consider incorporating elements of 'payments-by-outcomes' mechanisms, where practical, to emphasise and embed this commissioning approach which is based on specifying the outcomes to be achieved, rather than the service outputs to be delivered. Whilst payments-by-outcomes may be theoretically the most appropriate approach for outcomes-based services, it is recognised that proxies for outcomes may be required to make the approach practical. For example, an outcome an authority may wish to measure might be someone's personal outcome 'I want to maintain a nutritious and balanced diet', but a proxy measure that is observable, attributable and capable of being described, may be the person receiving help with meal preparation at agreed and specified times. Care logs documenting punctual assistance in meal preparation, in conjunction with positive feedback from the person receiving care about support received might be used as part of the basis of payment. It is also recognised that whilst these mechanisms are more commonplace in other types of commissioning, they are in their infancy for adult social care.

4.18 The design of any mechanism should, however, be introduced in cooperation with stakeholders and partners to ensure it is sustainable and ensure that innovation, and individual choice and control are not undermined. Any move to payments by outcomes should be achieved such that smaller, specialist, voluntary sector and community-based providers are not excluded from markets or disadvantaged, because for example, they did not have appropriate IT systems.

4.19 Local authorities should keep under review emerging ideas and best practice about outcomes based commissioning and payments by outcomes. For example:

Local authorities should have regard to the evolving guidance ' Commissioning for Better Outcomes' that was co-produced by the Department of Health, ADASS, LGA together with provider representatives and people with lived experience of care and support. This guidance is intended to support peer review and self-assessment of local authority commissioning, and represents a practical approach that underpins the themes of this statutory guidance.

4.20 Section 2 of the Care Act outlines local authorities' role in preventing, reducing or delaying the need for care and support. This includes how the authority facilitates and commissions services and how it works with other local organisations to build community capital and make the most of the skills and resources already available in the area. [footnote 10] Local authorities should consider working not just with traditional public sector partners like health, but also with a range of other partners to engage with communities to understand how to prevent problems from arising. [footnote 11]

4.21 Local authorities must facilitate markets that offer a diverse range of high-quality and appropriate services. In doing so, they must have regard to ensuring the continuous improvement of those services and encouraging a workforce which effectively underpins the market through:

The quality of services provided and the workforce providing them can have a significant effect on the wellbeing of people receiving care and support, and that of carers, and it is important to establish agreed understandable and clear criteria for quality and to ensure they are met.

4.22 When considering the quality of services, local authorities should be mindful of the capacity, capability, timeliness, continuity, reliability and flexibility of services delivered to support wellbeing, where appropriate, using the definitions that underpin the CQC's fundamental standards of care as a minimum, and having regard to the ASCOF framework of population outcomes. High quality services should enable people who need care and support, and carers, to meet appropriate personal outcome measures, for example, a domiciliary care service which provides care 2 days a week so that a carer who normally provides care can go to work, is not a quality service if it is not available on the specified days, or the care workers do not arrive in time to allow the carer to get to work on time.

4.23 Local authorities should also consider other relevant national standards including those that are aspirational, for example, any developed by the National Institute of Health and Care Excellence ( NICE). [footnote 12]

4.24 Local authorities should encourage a wide range of service provision to ensure that people have a choice of appropriate services; appropriateness is a fundamental part of quality. For example, a working age person should be able to choose care and support tailored for their situation, and not be faced with only a choice of facilities designed for older people, as this is unlikely to be appropriate to their situation, regardless of how high quality the facilities may be in their own contexts. Appropriate services will meet people's needs and reasonable preferences.

4.25 When arranging services themselves, local authorities must ensure their commissioning practices and the services delivered on their behalf comply with the requirements of the Equality Act 2010, and do not discriminate against people with protected characteristics; this should include monitoring delivery against the requirements of that Act. When shaping markets for services, local authorities should work to ensure compliance with this Act for services provided in their area that are not arranged and/or paid for by them. Local authorities should consider care and support services for their appropriateness for people from different communities, cultures and beliefs.

4.26 Local authorities should encourage services that respond to the fluctuations and changes in people's care and support needs, for example someone with fluctuating mobility or visual impairment. Local authorities should support the transition of services throughout the stages of people with care and support needs' lives to ensure the services provided remain appropriate. This is particularly important, for example, for young people with care and support needs and young carers transitioning to adulthood.

Example: Ensuring provision of appropriate services

Young people move from children's to adult care and support or providing support for situations where young carers become adults

For instance, many young people with learning disabilities leave full-time education at around this age and require new forms of care and support to live independently thereafter. Ensuring that services are made available to meet those needs is better for the quality of life of the young person in question. This could include things such as employment support, training, developing friendships or advice on housing options. It is equally important to think about ways of supporting carers at this time: some parent carers need extra support to juggle caring and paid work after their child leaves full time education. Loss of paid employment can have a significant impact on the carer's wellbeing and self-esteem as well as a significant impact on the family's financial circumstances. Similar issues can affect young carers. Taking a whole family approach to care and support planning that sets out a 'five-day offer' or appropriate supported living options for a young person, and support for a carer to manage an increased caring role (that allows them to stay in paid work if they wish to do so) can help families manage the transition and save money by avoiding unwanted out-of-county placements.

4.27 Local authorities should commission services having regard to the cost-effectiveness and value for money that the services offer for public funds. The Local Government Association Adult Social Care Efficiency Programme has advice on these issues and may be helpful.

4.28 People working in the care sector play a central role in providing high quality services. Local authorities must consider how to help foster, enhance and appropriately incentivise this vital workforce to underpin effective, high quality services. [footnote 13] [footnote 14]

4.29 Local authorities should consider, in particular, how to encourage training and development for the care and support workforce, including for the management of care services, through, for example, national standards recommended by Skills for Care:

And have regard to funding available through grants to support the training of care workers in the independent sector:

Local authorities should consider encouraging the training and development of care worker staff to at least the standard of the emerging Care Certificate currently being developed by Health Education England, Skills for Care and Skills for Health.

4.30 When commissioning services, local authorities should assure themselves and have evidence that service providers deliver services through staff remunerated so as to retain an effective workforce. Remuneration must be at least sufficient to comply with the national minimum wage legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments. Guidance on these issues can be found on the HMRC website.

4.31 When commissioning services, local authorities should assure themselves and have evidence that contract terms, conditions and fee levels for care and support services are appropriate to provide the delivery of the agreed care packages with agreed quality of care. This should support and promote the wellbeing of people who receive care and support, and allow for the service provider ability to meet statutory obligations to pay at least the national minimum wage and provide effective training and development of staff. It should also allow retention of staff commensurate with delivering services to the agreed quality, and encourage innovation and improvement. Local authorities should have regard to guidance on minimum fee levels necessary to provide this assurance, taking account of the local economic environment. This assurance should understand that reasonable fee levels allow for a reasonable rate of return by independent providers that is sufficient to allow the overall pool of efficient providers to remain sustainable in the long term. The following tools may be helpful as examples of possible approaches:

4.32 Local authorities should ensure that they themselves have functions and systems in place to fulfil their duties on market shaping and commissioning that are fit for purpose, with sufficient capacity and capability of trained and qualified staff to meet the requirements set out in the Care Act and this statutory guidance. In particular, local authorities should encourage relevant staff to be trained or developed to meet the National Skills Academy standards and programmes of training for care and support commissioners ' Commissioning Now ', or equivalent, and appropriate standards for commissioning related services such as housing services where appropriate. Local authorities should consider the skills and capabilities needed to support new approaches to commissioning, for example, outcomes-based and integrated commissioning. Local authorities should have regard to the emerging skill levels and qualifications being developed for commissioning staff by Skills for Care.

Supporting sustainability

4.33 Local authorities must work to develop markets for care and support that - whilst recognising that individual providers may exit the market from time to time - ensure the overall provision of services remains healthy in terms of the sufficiency of adequate provision of high quality care and support needed to meet expected needs. This will ensure that there are a range of appropriate and high quality providers and services for people to choose from.

4.34 Local authorities should understand the business environment of the providers offering services in their area and seek to work with providers facing challenges and understand their risks. Where needed, based on expected trends, local authorities should consider encouraging service providers to adjust the extent and types of service provision. This could include signalling to the market as a whole the likely need to extend or expand services, encourage new entrants to the market in their area, or if appropriate, signal likely decrease in needs - for example, drawing attention to a possible reduction in care home needs, and changes in demand resulting from increasing uptake of direct payments. The process of developing and articulating a Market Position Statement or equivalent should be central to this process.

4.35 Local authorities should consider the impact of their own activities on the market as a whole, in particular the potential impact of their commissioning and re-commissioning decisions, and how services are packaged or combined for tendering, and where they may also be a supplier of care and support. The local authority may be the most significant purchaser of care and support in an area, and therefore its approach to commissioning will have an impact beyond those services which it contracts. Local authorities must not undertake any actions which may threaten the sustainability of the market as a whole, that is, the pool of providers able to deliver services of an appropriate quality, for example, by setting fee levels below an amount which is not sustainable for providers in the long-term.

4.36 Local authorities should have effective communications and relationships with providers in their area that should minimise risks of unexpected closures and failures, and have effective interaction and communication with the Care Quality Commission ( CQC) about the larger and most difficult to replace providers that CQC will provide financial oversight for. Local authorities should review the intelligence they have about the sustainability of care providers drawn from market shaping, commissioning and contract management activities. [footnote 15] Where the authority believes there is a significant risk to a provider's financial viability, and where they consider it would be in the best interests of service users, the authority should consider what assistance may be provided or brokered to help the provider return to viability, and consider what actions might be needed were that provider to fail. For example, where a local authority has arranged services for people with a provider that appears to be at risk, undertaking early planning to identify potential replacement service capacity. Where it is apparent to a local authority that a provider is likely to imminently fail financially, either through its own intelligence or through information from the CQC, the authority should prepare to take steps to ensure continuity of care and support for people who have their care and support provided by that provider (see chapter 5 on managing provider failure).

Ensuring choice

4.37 Local authorities must encourage a variety of different providers and different types of services. This is important in order to facilitate an effective open market, driving quality and cost-effectiveness so as to provide genuine choice to meet the range of needs and reasonable preferences of local people who need care and support services, including for people who choose to take direct payments, recognising, for example, the challenges presented in remote rural areas for low volume local services.

4.38 Local authorities must encourage a range of different approaches to services to ensure people have a genuine choice of different types of service. This may be achieved by encouraging different types of service provider organisation, for example, independent private providers, third sector, voluntary and community based organisations, including user-led organisations, mutual and small businesses. Local authorities should note that the involvement of people with specific lived experience of the type of needs being met, may lead to better outcomes for people who use services and carers as they directly empathise with service users. This should recognise that the different underpinning philosophies, cultural sensitivity and style of service of these organisations may be more suited to some people with care and support needs. Local authorities should consider encouraging and supporting providers or taking other steps to promote an appropriate balance of provision between types of provider, having regard to competition rules and the need for fairness and legal requirements for all potential providers who may wish to compete for contracts. The TLAP guidance commissioning for provider diversity may be helpful to commissioners.

4.39 When commissioning services to meet people's eligible needs, where a local authority develops approved lists and frameworks that are used to limit the number of providers they work with, for example within a specific geographical area or for a particular service type to achieve strategic partnerships and value for money, the local authority must consider how to ensure that there is still a reasonable choice for people who need care and support.

4.40 For universally available services - for example, prevention - where the local authority does not have a duty to directly arrange services, it should have regard to facilitating this market through market shaping activity to encourage a diversity of service provision. If the authority decides to augment such universal services by directly contracting itself with one or more provider organisations, it should nevertheless continue to ensure that the overall mix of available services presents meaningful choice to people who need these services.

4.41 Local authorities should encourage a genuine choice of service type, not only a selection of providers offering similar services, encouraging, for example, a variety of different living options such as shared lives, extra care housing, supported living, support provided at home, and live-in domiciliary care as alternatives to homes care, and low volume and specialist services for people with less common needs. Local authorities may find the TLAP guidance 'Top Tips: commissioning for market diversity' helpful.

4.42 Choice for people who need care and support and carers should be interpreted widely. Local authorities should encourage choice over the way services are delivered, examples would include: developing arrangements so that care can be shared between an unpaid carer or relative and a paid care worker, a choice over when a service is delivered, choice over who is a person's key care worker, arranging for providers to collaborate to ensure the right provision is available, for example, a private provider and a voluntary organisation working together, choice over when a service is delivered. [footnote 16]

4.43 Local authorities must have regard to ensuring a sufficiency of provision - in terms of both capacity and capability - to meet anticipated needs for all people in their area needing care and support - regardless of how they are funded. This will include regularly reviewing trends in needs including multiple and complex needs, outcomes sought and achieved, and trends in supply, anticipating the effects and trends in prevention and community-based assets, and through understanding and encouraging changes in the supply of services and providers' business and investment decisions. [footnote 17]

4.44 When considering the sufficiency and diversity of service provision, local authorities should consider all types of service that are required to provide care and support for the local authority's whole population, including, for example:

support services and universal and community services that promote prevention

domiciliary (home) care

homes and other types of accommodation care

nursing care

live-in care services

specialist care

support for carers

reablement services

sheltered accommodation and supported living

shared lives services

other housing options

community support

counselling

social work

information, brokerage, advocacy and advice services

direct payment support organisations

4.46 Local authorities should facilitate the personalisation of care and support services, encouraging services (including small, local, specialised and personal assistant services that are highly tailored), to enable people to make meaningful choices and to take control of their support arrangements, regardless of service setting or how their personal budget is managed. Local authorities should have regard to the TLAP partnership agreement that sets out how shaping markets to meet people's needs and aspirations, including housing options, can promote choice and control. Alongside the suitability of living accommodation in Section 1 of the Act, Local authorities should consider how they can encourage the development of accommodation options that can support choice and control and promote wellbeing. Personalised care and support services should be flexible so as to ensure people have choices over what they are supported with, when and how their support is provided and wherever possible, by whom. The mechanism of Individual Service Funds by service providers, which are applicable in many different service types, can help to secure these kinds of flexibilities for people and providers.

4.47 Local authorities should help people who fund their own services or receive direct payments, to 'micro-commission' care and support services and/or to pool their budgets, and should ensure a supporting infrastructure is available to help with these activities. Many local authorities, for example, are utilising web-based systems such as e-Marketplaces for people who are funding their own care or are receiving direct payments to be able to search for, consider and buy care and support services on-line, consider joint purchases with others. This often involves offering information and advice about, for example, the costs and quality of services and information to support safeguarding. This should include facilitating organisations that support people with direct payments and those whose care is funded independently from the local authority to become more informed and effective consumers and to overcome potential barriers such as help to recruit and employ personal assistants and to assist in overcoming problems and issues. This activity should help to match people's wider needs with services.

4.48 Local authorities must facilitate information and advice to support people's choices for care and support. This should include where appropriate through services to help people with care and support (PDF, 1.09MB) needs understand and access the systems and processes involved and to make effective choices. This is a key aspect of the new duty to establish and maintain a universal information and advice service locally as set out in Section 4 of the Care Act. Information and advice services should be reviewed for effectiveness using people's experiences and feedback. This feedback forms part of the overall information a local authority considers about people's needs and aspirations.

4.49 Local authorities should facilitate local markets to encourage a sufficiency of preventative, enablement and support services, including support for carers to make caring more sustainable, such as interpreters, signers and communicator guides, and other support services such as 'telecare', home maintenance and gardening that may assist people achieve more independence and supports the outcomes they want.

4.50 Local authorities should encourage flexible services to be developed and made available that support people who need care and support, and carers who need support, to take part in work, education or training. Services should be encouraged that allow carers who live in one local authority area but care for someone in another local authority area to access services easily, bearing in mind guidance on ordinary residence.

Co-production with stakeholders

4.51 Local authorities should pursue the principle that market shaping and commissioning should be shared endeavours, with commissioners working alongside people with care and support needs, carers, family members, care providers, representatives of care workers, relevant voluntary, user and other support organisations and the public to find shared and agreed solutions. This should be in line with the Building Capacity and Partnership in Care Agreement. The TLAP guidance on co-production may be helpful, in particular the web-based tool People not process - Co-production in Commissioning.

Developing local strategies

4.52 Commissioning and market shaping should be fundamental means for local authorities to facilitate effective services in their area and it is important that authorities develop evidence-based local strategies for how they exercise these functions, and align these with wider corporate planning. Local authorities should have in place published strategies that include plans that show how their legislative duties, corporate plans, analysis of local needs and requirements (integrated with the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy), thorough engagement with people, carers and families, market and supply analysis, market structuring and interventions, resource allocations and procurement and contract management activities translate (now and in future) into appropriate high quality services that deliver identified outcomes for the people in their area and address any identified gaps. [footnote 18]

4.53 Since 2007 there has been a duty on local authorities and latterly clinical commissioning groups, through health and wellbeing boards, to undertake Joint Strategic Needs Assessments ( JSNA). JSNA is a process that assesses and maps the needs and demand for health and care and support, supports the development of joint Health and Wellbeing Strategies to address needs, understands community assets and informs commissioning of local health and care and support services that together with community assets meet needs.

4.54 Market shaping and commissioning intentions should be cross-referenced to JSNA, and should be informed by an understanding of the needs and aspirations of the population and how services will adapt to meet them. Strategies should be informed by and emphasise preventative services that encourage independence and wellbeing, delaying or preventing the need for acute interventions. Statutory guidance on JSNA and Joint Health and Wellbeing Strategies (PDF, 180KB) was published in March 2013. The ambition is for market shaping and commissioning to be an integral part of understanding and delivering the whole health and care economy, and to reflect the range and diversity of communities and people with specific needs, in particular:

4.55 A co-produced approach will stress the value of meaningful engagement with people at all stages, through design, delivery and evaluation, rather than simply as 'feedback'. Local authorities should publish and make available their local strategies for market shaping and commissioning, giving an indication of timescales, milestones and frequency of activities, to support local accountability and engagement with the provider market and the public.

4.56 It is suggested that a local authority can best commence its duties under Sections 5 (market shaping and commissioning) and 48 to 52 (provider failure) of the Care Act by developing with providers and stakeholders a published Market Position Statement. It may be helpful for Market Position Statements from neighbouring local authority areas to be coordinated to ensure a degree of consistency for people who will use the documents; this is particularly true for urban areas.

4.57 Local authorities should review strategies related to care and support together with stakeholders to ensure they remain fit for purpose, learn lessons, and adapt to incorporate emerging best practice, noting that peer review has a strong track record in driving improvement. It is suggested that reporting against strategies for care and support should form part of the local authority's Local Account.

4.58 Many public sector bodies, including local authorities, have radically transformed services by reconsidering commissioning in a strategic context. The Government's Commissioning Academy is working to promote such transformational approaches and local authorities should have regard to the emerging best practice it is producing.

4.59 Developing a diverse market in care and support services can boost employment and create opportunities for local economic growth, through for example, increasing employment opportunities for working-age people receiving care and carers, and developing the capacity of the care workforce. Local authorities should consider how their strategies related to care and support can be embedded in wider local growth strategies, for example, engaging care providers in local enterprise partnerships.

4.60 Recognising that changes to adult care and support are taking place at a time of the need to deliver services from constrained resources, local authorities should have regard to best practice on efficiency and value for money, in particular the LGA's Adult Social Care Efficiency Programme.

4.61 Local authority strategies should adhere to general standards, relevant laws and guidance, including the Committee of Standards in Public Life principles of accountability (PDF, 1MB), regularity and ensuring value for money alongside quality, and the HM Treasury guidance on managing public money.

4.62 Local authorities should develop standards on transparency and accountability to ensure citizens are able to contribute to and understand policy and review delivery. Standards should be in line with the codes of practice drawn up by the Department of Communities and Local Government.

4.63 Local authorities should take the lead to engage with a wide range of stakeholders and citizens in order to develop effective approaches to care and support, including through developing the JSNA and a Market Position Statement. While the duties under section 5 of the Care Act fall upon local authorities, successful market shaping is a shared endeavour that requires a range of coordinated action by commissioners and providers, working together with the citizen at the centre. Local authorities should engage and cooperate with stakeholders to reflect the range and diversity of communities and people with specific needs, for example:

people needing care and support themselves and their representative organisations

carers and their representative organisations

health professionals

social care managers and social workers

independent advocates

support organisations that help people who need care consider choices (including financial options)

provider organisations (including where appropriate private housing providers and registered social landlords)

the wider local population including individuals and communities who are less frequently heard (for example, LGBT communities where there may be a lack of data on care and support needs and preferences) or at risk from exclusion, including those who have communication issues and involving representatives of those who lack mental capacity [footnote 19].

4.64 Engagement with people needing care and support, people likely to need care and support, carers, independent advocates, families and friends, should emphasise understanding the needs of individuals and specific communities, what aspirations people have, what outcomes they would like to achieve, their views on existing services and how they would like services to be delivered in the future. [footnote 20] It should also seek to identify the types of support and resources or facilities available in the local community which may be relevant for meeting care and support needs, to help understand and build community capacity to reinforce the more formal, regulated provider market. In determining an approach to engagement, local authorities should consider methods that enable people to contribute meaningfully to:

4.65 Engagement with service providers should emphasise understanding the organisation's strategies, risks, plans, and encourage building trusting relationships and fostering improvement and innovation to better meet the needs of people in the area. Local authorities should consider engagement with significant suppliers of services to provider organisations, where this would help improve their understanding of markets, for example, engaging with employment and training services that might enable local authorities to gain access to frontline insights on care provision and the local workforce supply and training.

4.66 Local authorities should ensure that active engagement and consultation with local people is built into the development and review of their strategies for market shaping and commissioning, and is demonstrated to support local accountability (for example, via the Local Account).

4.67 Local authorities should engage positively with provider organisations to ensure fair play and necessary confidentiality. The Think Local Act Personal ( TLAP) partnership has produced guidance that may assist in the process - Stronger Partnerships for Better Outcomes and Commissioning the future: start a new conversation. Local authorities may also find the IPC 'Market shaping toolkit (MaST): supporting local authority and SME care provider innovation and collaboration' useful in supporting positive engagement with providers.

4.68 Local authorities should make available to providers available routes to register concerns or complaints about engagement and commissioning activities. Local authorities should consider the adequacy and effectiveness of these routes and processes as part of their engagement and trust-building activities.

Undertaking market shaping and commissioning

Understanding the market

4.69 Local authorities must understand local markets and develop knowledge of current and future needs for care and support services, and, insofar as they are willing to share and discuss, understand providers' business models and plans. This is important so that authorities can articulate likely trends in needs and signal to the market the likely future demand for different types of services for their market as a whole, and understand the local business environment, to support effective commissioning. Activities to understand the market should appropriately reflect an authority's strategic plans for integrating health, social care and related services and will require the cooperation of those other parties, as well as other authorities in the region, to ensure a complete picture.

4.70 Local authorities (through an engagement process, in concert with commissioners for other services where appropriate) should understand and articulate the characteristics of current and future needs for services. This should include reference to underpinning demographics, drivers and trends, the aspirations, priorities and preferences of those who will need care and support, their families and carers, and the changing care and support needs of people as they progress through their lives. This should include an understanding of:

4.71 It should include information and analysis of low incidence needs and multiple and complex conditions as well as more common conditions such as sensory loss. The RNIB has a tool to help local authorities scope the needs of people with sight impairment. It should also include information about likely changes in requirements for specialist housing required by people with care and support needs. The online tool SHOP@ developed by the Housing Learning and Improvement Network may be helpful.

4.72 Local authorities should have in place robust methods to collect, analyse and extrapolate this information about care and support needs, including as appropriate information about specific conditions (for example, neurological conditions such as Stroke, Parkinson's, and Motor Neurone Disease), and multiple and complex needs. This should sit alongside information about providers' intentions to deliver support over an appropriate timescale - likely to be at least 5 years into the future, with alignment to other strategic timeframes. Data collection should include information on the quality of services provided in order to support local authority duties to foster continuous improvement. This could be achieved, for example, by collecting and acting on feedback from people who receive care, their families and carers alongside information on the specific nature of the services people receive (for example, regularity and length of homecare visits). This will allow for an assessment of correlation between customer experience and service provision. Data collection must be sufficient to allow local authorities to meet their duties under the Equality Act 2010.

4.73 Local authorities should include in their engagement and analysis, services and support provided by voluntary, community services, supported housing providers, and other groups that make up 'community assets' and plan strategically to encourage, make best use of and grow these essential activities to integrate them with formal care and support services.

4.74 Local authorities should also seek to understand trends and changes to the levels of support that are provided by carers, and seek to develop support to meet their needs, noting that amongst other sources, census data include information on carers and their economic activity. Local authorities should understand the trends and likely changes to the needs of carers in employment, so as to better plan future support.

4.75 In order to understand future trends in needs and demands, local authorities should include an understanding of people who are or are likely to be both wholly or partly state funded, and people who are or are likely to be self-funding. It should also include an analysis of those self-funding people who are likely to move to state funding in the future.

4.76 The understanding of needs should also include an understanding of the likely demand for state-funded services that the local authority will need to commission directly, and state-funded services likely to be provided through direct payments and require individuals to 'micro-commission' services. Local authorities should also consider the extent to which people receiving services funded by the state may wish to 'top up' their provision to receive extra services or premium services - that is, the assessment of likely demand should be for services that people are likely to need and be prepared to pay for through top ups.

4.77 The assessment of needs should be integrated with the process of developing, refining and articulating a local authority's Joint Strategic Needs Assessment. Where appropriate, needs should be articulated on an outcomes basis.

4.78 In order to gather the necessary information to shape its market, local authorities should engage with providers (including the local authority itself if it directly provides services) to seek to understand and model current and future levels of service provision supply, the potential for change in supply, and opportunities for change in the types of services provided and innovation possible to deliver better quality services and greater value for money. Local authorities should understand the characteristics of providers' businesses, their business models, market concentration, investment plans. Information about both supply and expected demand for services should be made available publicly to help facilitate the market and empower communities and citizens when considering care and support. Smaller care providers should be included in engagement. Local authorities may find helpful the guidance Supporting Local Authority and SME Care Provider Innovation and Collaboration that was co-produced by the Department of Health with ADASS and LGA, provider organisations and people with lived experience.

4.79 Assessment of supply and potential demand should include an awareness and understanding of current and future service provision and potential demand from outside the local authority area where this is appropriate, for example in considering services to meet highly specialised and complex needs, care and support may not be available in the local authority area, but only from a small number of specialised providers in the country. Consideration should be given to whether such services might better be commissioned and facilitated regionally.

Facilitating the development of the market

4.80 Local authorities should collaborate with stakeholders and providers to bring together information about needs and demands for care and support with that about future supply, to understand for their whole market the implications for service delivery. This will include understanding and signalling to the market as a whole the need for the market to change to meet expected trends in needs, adapt to enhance diversity, choice, stability and sustainability, and consider geographic challenges for particular areas. To this picture, local authorities should add their own commissioning strategy and future likely resourcing for people receiving state-funding. Local authorities should consider co-ordinating these market shaping and related activities with other neighbouring authorities where this would facilitate better outcomes.

4.81 Local authorities should consider how to support and empower effective purchasing decisions by people who self-fund care or purchase services through direct payments, recognising that this can help deliver a more effective and responsive local market.

4.82 Local authorities should ensure that the market has sufficient signals, intelligence and understanding to react effectively and meet demand, a process often referred to as market structuring or signalling. Local authorities should publish, be transparent and engage with providers and stakeholders about the needs and supply analysis to assist this signalling. It is suggested that this is best achieved through the production and regular updating of a document like a Market Position Statement that clearly provides evidence and analysis and states the local authority's intent. A Market Position Statement is intended to encourage a continuing dialogue between a local authority, stakeholders and providers where that dialogue results in an enhanced understanding by all parties is an important element of signalling to the market.

4.83 A Market Position Statement should contain information on: the local authority's direction of travel and policy intent, key information and statistics on needs, demand and trends, (including for specialised services, personalisation, integration, housing, community services, information services and advocacy, and carers' services), information from consumer research and other sources about people's needs and wants, information to put the authority's needs in a national context, an indication of current and future authority resourcing and financial forecasts, a summary of supply and demand, the authority's ambitions for quality improvements and new types of services and innovations, and details of, or cross-references to the local authority's own commissioning intentions, strategies and practices [footnote 22].

4.84 Developing and then making publicly available a Market Position Statement is one way a local authority can meet its duties to make available information about the local market, and demonstrates activity to meet the other parts of Section 5 of the Act. The DCMQC web pages include exemplar Market Position Statements and links to examples of good practice. Market Position Statements for care and support services should combine, cross-refer or otherwise complement other similar statements for related services, particularly where there is an integrated approach or ambition, for example, housing. The paper from the Housing Learning and Improvement Network on developing MPS for housing services may be helpful.

4.85 As part of developing and publishing a document like a Market Position Statement, local authorities should engage with stakeholders and partners to structure their markets. This could include:

discussions with potential providers

actively promoting best practice and models of care and support

understanding the business planning cycles of providers

aligning interactions and supporting the provider's business planning

identifying and addressing barriers to market entry for new providers

facilitating entry to the market through advice and information

streamlining the authority's own procurement processes

promoting diversification of provider organisations

working with providers on an 'open-book accounting' approach [footnote 23] to cost current and future services and ensure provider sustainability

supporting providers through wider local authority activity - planning, business support and regeneration

4.86 Local authorities may consider that market structuring activity - signalling to the market and providing assistance - is not achieving the strategic aims as quickly or as effectively as needed, and may wish to consider more direct interventions in the market. Market interventions may also be planned as part of the market shaping and commissioning strategies where there is an immediate need for intervention.

4.87 Market interventions could for example include: refocusing local authority business support initiatives onto the care and support sector, exploring how local care and support projects could attract capital investments and support and what guarantees may be needed, encouraging and supporting social enterprises, micro-enterprises, Community Interest Companies, and User-Led Organisations (for example, incentivising innovation by third sector providers, possibly through grant funding), exploring planning barriers and using planning law, offering access to training and development opportunities.

4.88 Local authorities should consider monitoring progress toward the ambitions set out in the Market Position Statement, and making that progress public along with information about its own commissioning decisions, as part of a commitment to transparency and accountability. This would demonstrate that the authority's commissioning activity is in line with the ambition and direction of travel articulated in its Market Position Statement, and might be achieved by including this information in regular updates to the Market Position Statement.

Case Study Facilitating the market

Warwickshire Council's Market Position Statement for Older People identified a significant growth in the number of people living with dementia in the county, coupled with a declining trend in the number of people accessing traditional day services in the previous 4 to 5 years. Day services provide stimulation for the person living with dementia as well as a break for the person's carer.

Following this the Council undertook a full review of Dementia Community Support. This included evaluating the role of services funded by the NHS and the Council and also those provided directly by the voluntary and community sector.

The Council held an engagement event to establish what customers and carers want dementia Community Support services to look like and deliver. This identified the gaps between supply and demand in more detail and at a local level. The event also gathered information from providers and voluntary and community groups about the challenges of delivering services. Providers identified commissioning models which promote strong and stable service delivery whilst still allowing flexible responses to meet individual needs as particularly useful. As a result of this activity, the Council is now in the process of procuring a new service model for Dementia Community Support. The model will include information and advice, community services, building-based respite and specialist support.

4.89 The Health and Social Care Act 2012 sets out specific obligations for the health system and its relationship with care and support services. It gives a duty to NHS England, clinical commissioning groups, Monitor and Health and Wellbeing Boards to make it easier for health and social care services to work together to improve outcomes for people. Section 3 of the Care Act places a corresponding duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services, such as housing.

4.90 Local authorities should also consider working with appropriate partners to develop integration with services related to care and support such as housing, employment services, transport, benefits and leisure services. Local authorities should prioritise integration activity in areas where there is evidence that effective integration of services materially improves people's wellbeing, for example, end of life care, and should take account of the key national and local priorities and objectives of the Better Care Fund, for example, stopping people reaching crisis and reducing the emergency admissions to hospitals.

4.91 Integrated services built around an individual's needs are often best delivered through the home. The suitability of living accommodation is a core component of an individual's wellbeing and when developing integrated services, local authorities should consider the central role of housing within integration, with associated formal arrangements with housing and other partner organisations.

4.92 Local authorities should work towards providing integrated care and support, providing services that work together to provide better outcomes for individuals who need care and support and enhancing their wellbeing, noting that this will require the sharing of information about current and future needs and likely service provider's responses to underpin a holistic approach to developing integrated care and support pathways. Further information can be found in the chapters of this statutory guidance on integration (chapters 15 to 18). NHS guidance and LGA case studies on integration may be helpful, together with the toolkit for integration developed by North West London Whole System Integrated Care (particularly chapter 7 on budget pooling, governance arrangements and commissioning issues in general).

4.93 Local authorities should consider with partners, the enabling activities, functions and processes that may facilitate effective integrated services. For example Bexley LA and CCG joint commissioning of preventative services. These will include consideration of: joint commissioning strategies, joint funding, pooled budgets, lead commissioning, collaborative commissioning, working with potential service providers to consider innovative ways of arranging and delivering services, and making connections to public health improvement.

Securing supply in the market and assuring its quality and value for money through contracting

4.94 Local authorities should consider best practice on commissioning services, for example the NAO guidance to ensure they deliver quality services with value for money. 'Value for money' means optimal use of resources to achieve intended outcomes, and must reference the quality of service delivered and the outcomes achieved for people's wellbeing, and should not be solely based on achieving the lowest cost. Achieving value for money may mean arranging service provision collaboratively with other authorities, in order to secure viable, quality services that meet the demands identified, for example, low-volume services.

4.95 Commissioning and procurement practices must deliver services that meet the requirements of the Care Act and all related statutory guidance. Re-commissioning and replacing services represents a particular challenge and should be carried out so as to maintain quality and service delivery that supports the wellbeing of people who need care and support and carers, and guards against the risk of a discontinuity of care and support for those receiving services. For example, multiple contracts terminating around the same time may destabilise local markets if established providers lose significant business rapidly and staff do not transfer smoothly to new providers.

4.96 De-commissioning services where there is to be no replacement service should similarly be carried out so as to maintain the wellbeing of people who need care and support, and carers, and ensures that their eligible needs continue to be met.

4.97 Local authorities should consider the contract arrangements they make with providers to deliver services, including the range of block contracts, framework agreements, spot contracting or 'any qualified provider' approaches, to ensure that the approaches chosen do not have negative impacts on the sustainability, sufficiency, quality, diversity and value for money of the market as a whole - the pool of providers able to deliver services of appropriate quality.

4.98 A local authority's own commissioning should be delivered through a professional and effective procurement, tendering and contract management, monitoring, evaluation and decommissioning process that must be focussed on providing appropriate high quality services to individuals to support their wellbeing and supporting the strategies for market shaping and commissioning, including all the themes set out in this guidance.

4.99 Local authorities should ensure that they understand relevant procurement legislation, and that their procurement arrangements are consistent with such legislation and best practice. Local authorities should be aware that there is significant flexibility in procurement practices to support effective engagement with provider organisations and support innovation in service delivery, potentially reducing risks and leading to cost-savings. The Office of Fair Trading produced guidance to help public purchasers understand the flexibilities so as to support service transformations through better commissioning. The Market Shaping Toolkit, produced by the Institute of Public Care includes a section summarising recent changes to procurement rules, including EU procurement rules and the implications for commissioners. Government has also produced guidance on when reserved contracts may be allowable for organisations employing a significant number of disabled people these documents may be helpful to commissioners.

4.100 Local authorities should ensure that their procurement and contract management and monitoring systems provide direct and effective links to care service managers and social workers to ensure the outcomes of service delivery matches individual's care and support needs and that where the local authority arranges services, people are given a reasonable choice of provider. Contract management should take account of feedback from people receiving care and support.

4.101 Local authorities should ensure that where they arrange services, the assessed needs of a person with eligible care and support needs is translated into effective, appropriate commissioned services that are adequately resourced and meet the wellbeing principle of the Act. For example, short home-care visits of 15 minutes or less are not appropriate for people who need support with intimate care needs, though such visits may be appropriate for checking someone has returned home safely from visiting a day centre, or whether medication has been taken (but not the administration of medicine) or where they are requested as a matter of personal choice.

4.102 When commissioning services, local authorities should pay particular attention to ensuring that providers have clear arrangements in place to prevent abuse or neglect. This should include assuring themselves, through their contracting arrangements, that a provider is capable and competent in responding to allegations of abuse or neglect, including having robust processes in place to investigate the actions of members of staff. Local authorities should be clear what information they expect from providers (for example, where there are allegations of abuse, what action the provider is taking or has taken and what the outcome is) and where providers are expected to call upon local authorities to lead a Section 42 enquiry (where the management of the provider is implicated for instance), or to involve the CCG (for health matters) or police (for example, in the case of potential crimes). There should be clear agreement about how local partners work together on investigations and what their respective roles and responsibilities are.

4.103 When commissioning services, local authorities should undertake due diligence about the financial sustainability and effectiveness of potential providers to deliver services to agreed criteria for quality, and should assure themselves that any recent breaches of regulatory standards or relevant legislation by a potential provider have been corrected before considering them during tendering processes. For example, where a provider has previously been in breach of national minimum wage legislation, a local authority should consider every legal means of excluding them from the tendering process unless they have evidence that the provider's policies and practice have changed to ensure permanent compliance.

4.104 Contracts should incentivise value for money, sustainability, innovation and continuous improvement in quality and actively reward improvement and added social value. Contracts and contract management should manage and eliminate poor performance and quality by providers and recognise and reward excellence.

4.105 Local authorities are under a duty to consider added social value when letting contracts through the Public Services (Social Value) Act 2012 and are required to consider how the services they procure, above relevant financial thresholds, might improve the economic, social and environmental wellbeing of the area. Local authorities should consider using this duty to promote added value in care and support both when letting contracts to deliver care and support, and for wider goods and services. This should include considering whether integrated services, voluntary and community services and 'community capital' could be enhanced, recognising that these community assets provide the bedrock of care and support that commissioned and bought services supplement. Local authorities should consider the range of funding mechanisms that are available to support market interventions to support community based organisations such as seed funding and grants.

4.106 All services delivered should adhere to national quality standards, with procedures in place to assure quality, safeguarding, consider complaints and commendations, and continuing value for money, referencing the CQC standards for quality and CQC quality ratings.

4.107 Local authorities may consider delegating some forms of contracting to brokers and people who use care and support to support personal choice for people who are not funded by the local authority and those taking direct payments, with appropriate systems in place to underpin the delivery of safe, effective appropriate high quality services through such routes. Where functions and activities are delegated, local authorities should ensure that appropriate elements of this statutory guidance are included in contractual conditions, for example, allowing engagement in developing Market Position Statements. Local authorities should also consider providing support to people who wish to use direct payments to help them make effective decisions through, for example, Direct Payment support organisations.

4.108 Local authority procurement and contract management activities should seek to minimise burdens on provider organisations and reduce duplications, where appropriate, using and sharing information, with for example the CQC.

4.109 Recognising that procurement is taking place against a backdrop of significant demand on commissioners to achieve improved value for money and make efficiencies, local authorities should consider emerging practice on achieving efficiencies without undermining the quality of care.

Further information/best practice

4.110 The different approaches provided in footnotes in this guidance are meant as illustrative examples rather than recommendations or endorsements.

4.111 The Department of Health funded a programme during 2013 to 2014 to support local authorities prepare for market shaping duties; further information is available on the Developing Care Markets for Quality and Choice programme website. The Department also funded a project to develop commissioning standards, Commissioning for Better Outcomes, which are designed to support local authorities, through peer challenge and self-assessment to move towards commissioning practices which underpins the themes of this statutory guidance.

4.112 The Developing Care Markets programme, Commissioning for Better Outcomes, and the market shaping toolkit develop the themes presented in this statutory guidance and will themselves point to examples of best practice and support tools that demonstrate how these themes have been introduced and delivered effectively.

5. Managing provider failure and other service interruptions

This chapter provides guidance on:

Sections 19 and 48 to 57 of the Care Act 2014

The Care and Support (Business Failure) Regulations 2015

This chapter covers:

service interruptions because of business failure, this chapter explains what local authorities must do if a provider is unable to carry on because of business failure

business failure involving a provider in the Care Quality Commission's (CQC) market oversight regime. This section explains CQC's role if business failure occurs and the link with the local authority's temporary duty

business failure involving a provider not in the CQC market oversight regime. This section explains what local authorities must do if the business failure involves a provider not in the CQC regime

administration and other insolvency procedures. This section explains the relationship between local authorities and persons such as an Administrator appointed in insolvency proceedings

service interruptions other than business failure. This section explains local authorities' powers where a service is interrupted for other reasons

the link with local authorities' duties in respect of market shaping. This section explains how local authorities' market shaping activities can play a part in effectively addressing service interruptions

the need for contingency planning. This section explains how local authorities should consider having contingency plans in advance to address the service interruptions that pose the greatest risk locally

5.1 The possibility of interruptions to care and support services causes uncertainty and anxiety for people receiving services, their carers, family and friends. This guidance explains how the Care Act makes provision to ensure that, in such circumstances, the care and support needs of those receiving the service continue to be met. It describes local authorities' powers and duties when services are at risk of interruption in general and, in particular, when the interruption is because a provider's business has failed. It provides guidance to local authorities on the exercise of those powers and the discharge of those duties.

5.2 Interruptions can arise from a number of different causes. An example is when a provider of services faces commercial difficulties that put the continuation of their business under threat. In 2011, Southern Cross Healthcare, then the biggest provider of residential care services in the United Kingdom, ran into financial difficulties and it was possible the business would have to close down, putting services to residents at risk. While Southern Cross was a provider of services in all parts of the country, smaller local providers can also encounter commercial issues which cause uncertainty for people receiving care and support. Local authorities have an important role in situations where a provider is unable to continue to supply services because of business failure.

5.3 There are numerous other situations that can cause disruption to care and support services. Some may impact on the whole business - for example, a provider decides to close the business down - while others impact on a particular service - for example, a meningitis outbreak at a care home. Local authorities should use their powers to act in such cases, as set out below.

Definitions

5.4 'Business failure' is defined in The Care and Support (Business Failure) Regulations 2015 (PDF, 45KB). These Regulations define what is meant by 'business failure' and explain the circumstances in which a person is to be treated as being unable to do something because of business failure. Business failure is defined by a list of different events such as the appointment of an administrator, the appointment of a receiver or an administrative receiver (the full list appears in the Regulations). Service interruption because of 'business failure' relates to the whole of the regulated activity and not to parts of it.

5.5 'Temporary duty' or 'duty' means the duty on local authorities to meet needs in the case of business failure. 'Temporary' means the duty continues for as long as the local authority considers it necessary. The temporary duty applies regardless of whether a person is ordinarily resident in the authority's area. The duty applies from the moment the authority becomes aware of the business failure. The actions to be taken by authorities will depend on the circumstances, and may include the provision of information. The duty is to meet needs but authorities have discretion as to how they meet those needs.

Service interruptions because of business failure

5.6 Business failure of a major provider is a rare and extreme event and does not automatically equate to closure of a service. It may have no impact on residents or the people who use the services. However, if a provider of any size is unable to continue because of business failure, the duties on local authorities are as follows.

5.7 Local authorities are under a temporary duty to meet people's needs when a provider is unable to continue to carry on the relevant activity in question because of business failure. The duty applies when a service can no longer be provided and the reason for that is that the provider's business has failed. If the provider's business has failed but the service continues to be provided then the duty is not triggered. This often may happen in insolvency situations where an administrator is appointed and continues to run the service.

5.8 The duty applies where a failed provider was meeting needs in the authority's area. It does not matter whether or not the authority has contracts with that provider, nor does it matter if all the people affected are self-funders (for example, arranging and paying for their own care). The duty is in respect of people receiving care by that provider in that authority's area - it does not matter which local authority (if any) made the arrangements to provide services.

5.9 The needs that must be met are those that were being met by the provider immediately before the provider became unable to carry on the activity. Local authorities must ensure the needs are met but how that is done is for the local authority to decide, and there is significant flexibility in determining how to do so, as set out in section 8 of the Care Act. It is not necessary to meet those needs through exactly the same combination of services that were previously supplied. However, when deciding how needs will be met, local authorities must involve the person concerned, any carer that the person has, or anyone whom the person asks the authority to involve (see chapter 10 on care and support planning). Where the person lacks capacity to ask the authority to do that, the local authority must involve anyone who appears to the authority to be interested in the person's welfare. Where a carer's service is involved, local authorities must involve the carer and anyone the carer asks the authority to involve. The authority must take all reasonable steps to agree how needs should be met with the person concerned. It should seek to minimise disruption for people receiving care, in line with the wellbeing principle and, although authorities have discretion about how to meet needs, the aim should be to provide a service as similar as possible to the previous one.

5.10 An authority has the power, where it considers this necessary to discharge the temporary duty, to request that the provider, or anyone involved in the provider's business as it thinks appropriate, to supply it with information that it needs. This may involve, for example, up-to-date records of the people who are receiving services from that provider, to help the local authority to identify those who may require its support.

5.11 The authority should act promptly to meet people's needs. The lack of a needs or carer's assessment or a financial assessment for a person must not be a barrier to action. Neither is it necessary to complete those assessments before or whilst taking action. Similarly, authorities must meet needs irrespective of whether those needs would meet the eligibility criteria. All people receiving services in the local authority's area are to be treated the same. In particular, how someone pays for the costs of meeting their needs - for example, in full by the person themselves - must have no influence on whether the authority fulfils the duty. However, an authority may charge the person for the costs of meeting their needs, and it may also charge another local authority which was previously meeting those needs, if it temporarily meets the needs of a person who is not ordinarily resident in its area. The charge must cover only the actual cost incurred by the authority in meeting the needs. No charge must be made for the provision of information and advice to the person.

5.13 In fulfilling this function, authorities must follow the general duties to cooperate (see chapter 15). Where a person is not ordinarily resident in an authority's area, that authority must cooperate with the authority which was arranging for the needs to be met previously (for example, before the provider became unable to carry on because of business failure). The duty of cooperation applies equally where the needs being met previously were paid for (in full or in part) by another authority through a direct payment to the person concerned.

5.14 Authorities that disagree on whether and/or how the law (for example, section 48) applies in these circumstances may apply to the Secretary of State for a determination of a dispute under the procedure that applies to disputes over ordinary residence or continuity of care (see chapters 19 and 20).

5.15 All of the duties on local authorities described above apply equally if the needs the authority must meet were, at the time the provider became unable to carry on because of business failure, being met under arrangements made by local authorities in Wales, Scotland or Northern Ireland under the legislation that applies in those countries. English local authorities may recover from their counterparts in Wales, Scotland and Northern Ireland the costs incurred in meeting the person's needs. If applicable, English authorities can also recover costs from the person themselves (other than the costs of needs being met or funded by the authorities mentioned above).

5.16 Disputes between authorities in England, Wales, Scotland or Northern Ireland about whether or how the temporary duty applies in cross-border situations are to be resolved under the legislation governing disputes about cross-border placements in Schedule 1 and the relevant regulations (see chapter 22).

Business failure involving a provider in the CQC oversight regime

5.17 In April 2015, the financial 'health' of certain care and support providers became subject to monitoring by the Care Quality Commission ( CQC). The Care and Support (Market Oversight Criteria) Regulations 2015 set out the entry criteria for a provider to fall within the regime. These are intended to be providers which, because of their size, geographic concentration or other factors, would be difficult for one or more local authorities to replace, and therefore where national oversight is required. CQC will determine which providers satisfy the criteria using data available to it. It will notify the providers which meet the entry criteria.

5.18 CQC must then assess the financial sustainability of the provider's business. If it assesses there is a significant risk to the financial sustainability of the provider's business, there are certain actions CQC may take with that provider (none of which involve local authorities).

5.19 Where CQC is satisfied that a provider in the regime is likely to become unable to continue with their activity because of business failure, it is required to tell the local authorities which it thinks will be required to carry out the temporary duty, so that they can prepare for the local consequences of the business failure. CQC will inform local authorities once it is satisfied the provider is unlikely to be able to carry on because of business failure. CQC's trigger to contact authorities is that it believes the whole of the regulated activity in respect of which the provider is registered is likely to fail, not parts of it. It is not required to make contact with authorities if, say, a single home owned by the provider in the regime is likely to fail because it is unprofitable and the CQC is not satisfied that this will lead to the whole of the provider's relevant regulated activity becoming unable to continue. In these circumstances, it is the provider's responsibility to wind down and close the service in line with its contractual obligations and it is expected that providers would do so in a planned way that does not interrupt people's care.

5.20 Where CQC considers it necessary to do so to help a local authority to carry out the temporary duty, it may request the provider to provide it with information and CQC must then give the information, and any further relevant information it holds, to the local authorities affected. If the CQC is of the view that a provider is likely to become unable to continue with its activity because of business failure, the CQC should work closely together with the affected local authorities to help them fulfil their temporary duty. In exercising its market oversight functions, CQC must have regard to the need to minimise the burdens it imposes on others.

Business failure involving a provider not in the CQC oversight regime

5.21 Regulations set out the entry criteria into the CQC regime. It will be for CQC to apply those regulations and decide which providers are included. There are many thousands of providers in England and only a relatively small number of providers fall in the regime. The providers outside the regime will in the main be those with small and medium size businesses.

5.22 The temporary duty on local authorities to meet needs in the case of business failure applies regardless of whether the provider is in the market oversight regime. Despite the CQC having a market oversight responsibility, local authorities have responsibility to ensure continuity of care in respect of business failure of all registered providers.

Administration and other insolvency procedures

5.23 Business failure (as defined) will usually involve an official being appointed for example, an Administrator to oversee the insolvency proceedings. An Administrator represents the interests of the creditors of the provider that has failed and will typically try to rescue the company as a going concern. In these circumstances, the service will usually continue to be provided, and the exercise of local authorities' temporary duties may not be called for. It is not for local authorities to become involved in the commercial aspects of the insolvency, but they should cooperate with the Administrator if requested. Local authorities should, insofar as it does not adversely affect people's safety and wellbeing, support efforts to maintain service provision by, for example, not prematurely withdrawing people from the service that is affected, or ceasing to commission that service.

Service interruptions other than business failure

5.25 Sections 18 and 20 of the Care Act set out when a local authority must meet a person's eligible needs. They place duties on the local authority. If the circumstances described in the sections apply and the needs are eligible, the local authority must meet the needs in question. These duties apply whether or not business failure is at issue.

5.26 Section 19 of the Care Act covers the circumstances where care and support needs may be met for example, circumstances where no duties arise under section 18 but the local authority may nevertheless meet an adult's needs. In particular, section 19(3) permits a local authority to meet needs which appear to it to be urgent. In this context, 'urgent' takes its everyday meaning, subject to interpretation by the courts, and may be related to, for example, time, severity. This is likely to be the case in many situations where services are interrupted but business failure is not the cause. The power in section 19(3) can be exercised in order to meet urgent needs without having first conducted a needs assessment, financial assessment or eligibility criteria determination. The local authority may meet urgent needs regardless of whether the adult is ordinary resident in its area. This means the local authority can act quickly if circumstances warrant. The power to meet urgent needs is not limited by reference to services delivered by particular providers and is thus available where urgent needs arise as a result of service failure of an unregistered provider (for example, a provider of an unregulated social care activity). The power may also be used in the context of quality failings of providers if that is causing people to have urgent needs.

5.27 This section gives local authorities a power to act to meet needs, but it does not require that authorities must act. Whether or not to act is a decision for the authority itself but authorities should consider the examples which follow.

5.28 In relation to service interruption, circumstances that might lead to the exercise of the power include where the continued provision of care and support to those receiving services is in imminent jeopardy and there is no likelihood of returning to a 'business as usual' situation in the immediate future, leading to urgent needs. Not all situations where a service has been interrupted or closed will merit local authority involvement because not all cases will result in adults having urgent needs. For example, if a care home closes and residents have agreed to the provider's plans to move the residents to a nearby care home that the provider also owns, local authorities will not necessarily have to become actively involved as urgent needs might not arise. On the other hand, the local authority might wish to be satisfied that the alternative home can adequately meet the urgent needs. Whether to act under this power is a judgement for the local authority to make in the first instance.

5.29 If a provider has not failed, it is primarily the provider's responsibility to meet the needs of individuals receiving care in accordance with its contractual liabilities. The local authority may wish to be involved to help with this. The power provides an ultimate backstop for use where the provider cannot or will not meet its responsibilities, and where the authority judges that the needs of individuals are urgent (and where the local authority is not already under a duty to meet the adult's needs, for example under section 18).

5.30 A service closure may be temporary (for example, unforeseen absence of qualified staff) or permanent (for example, the home is to be sold on for use as a hotel). Similarly, an emergency closure or planned closure may be involved. What matters in deciding whether to meet needs is whether the needs of the people affected appear to be urgent. For example, the sale of a provider's business may be a positive development for residents, service users and commissioners alike and may not lead to urgent needs. These powers are not intended to inhibit the effective operation of a market in improving choice, quality and investment.

5.31 Where the local authority does get involved in ensuring needs continue to be met, that involvement might be short-lived (for example, the giving of advice) or enduring over some months (for example, overseeing the movement of residents following the closure of several homes owned by the same provider). Acts of God (for example, flooding) or complications with suppliers (for example, a nursing agency refuses to continue to provide qualified staff) should not in themselves automatically be considered to trigger the use of the power. In all cases, the test is whether the local authority considers there is an urgent need to be met.

5.32 When considering action in relation to service interruption or closure, there is a balance to be struck. On the one hand, if local authorities know there is a serious risk to the continued provision of a service, they may consider not using that service temporarily or reassigning people using that service to an alternative service. On the other hand, it may be possible and justifiable for the local authority to act in a way that maximises the provider's chances of continuing to provide the service and avoiding a business failure. Local authorities should weigh the consequences of their actions before deciding how to respond, in particular, how their actions might impact on the likelihood of the service continuing. Certain actions may increase the risk of precipitating the business failure.

5.33 In summary, each service interruption should be considered on its facts and assessed by the local authority through a process of risk assessment. It is for the local authority to decide if it will act to meet a person's needs for care and support which appear to it to be urgent. In exercising this judgement the local authority must act lawfully, including taking decisions that are reasonable.

5.34 Section 5 and the associated guidance sets out authorities' duties to promote the efficient and effective operation of the local market in care and support services (see chapter 4). Central to this function is the need to ensure that the authority has, and makes available, information about the providers of care and support services in its area and the types of services they provide. This gathering of market intelligence is equally relevant to authorities' responses to business failure and other service interruptions. Where alternative services are to be put in place, an effective response requires a thorough knowledge of the market, which providers provide which services, the quality of each provider's services and where there is spare capacity in service provision. In anticipating potential service interruptions, there is also a need to know the vulnerabilities in the operation of the market. For example, is there only one local provider of a particular service and no alternatives exist locally, or does one provider cater for a substantial part of the local market and alternative capacity could not be found easily? Service interruptions involving such providers are likely to be more difficult to address. Local authorities should have knowledge of market vulnerabilities, market capacity and capabilities such as this in order to respond effectively to service interruptions.

5.35 Local authorities should understand how providers in their area are coping with the current trading conditions through discussions with the providers themselves. Authorities can achieve this without the collection of detailed financial metrics, accounts and business plans that CQC might utilise in respect of the major corporate providers in the regime. The business failure of providers outside the CQC regime will be on a smaller scale, usually with lesser impact, and local authorities should take a proportionate approach to anticipating or getting early warning of business failure. Local authorities may find the Cordis Bright guidance and toolkit: Assessing care market and provider sustainability helpful in developing a proportionate approach. Given CQC is responsible for monitoring the financial sustainability of providers falling within the market oversight scheme, it is not necessary for authorities also to ask for detailed financial information from these providers.

The need for contingency planning

5.36 Most service interruptions are on a small scale and are easily managed but service interruptions on a large scale pose far greater problems. If a provider which operates nationwide fails, few local authorities are likely to be able to respond effectively on their own. Local authorities should consider how they would respond to different service interruptions and, where the involvement of neighbouring authorities would be essential in order to maintain services, ensure effective liaison and information sharing arrangements are set up in advance. Close cooperation between authorities may be particularly required where an authority has a substantial number of people placed within its area by other authorities.

5.37 As part of contingency planning, authorities should discuss with local providers which services they would be willing and able to provide if the need arose because another local provider had failed. This should help to facilitate a prompt response that would help to maintain continuity of care for the people affected. Through its market shaping activities, authorities should encourage trust between the parties so that effective relationships exist where urgent needs are to be met.

5.38 Service interruptions are often the cause of much anxiety and media attention. Local authorities should have the capacity to react quickly to any media reporting of service interruptions, whether large scale or small, if uncertainty and anxiety are to be minimised.

5.39 Local authorities should consider how to undertake contingency planning most effectively at a local level, to ensure preparedness for possible service interruptions in the future. Service interruptions are often unforeseen and require rapid response. Local authorities should review which service interruptions pose the greatest risk in their locality and consider developing contingency plans in advance, in conjunction with local partners. This may include regional activity with other local authorities in the same area, where risks are better shared between a number of neighbouring authorities.

5.40 Local authorities already plan and manage challenging situations as a matter of course, for example, school closures from public health outbreaks or the impact of extreme weather. The aim should be that contingency planning for social care sits alongside authorities' other emergency planning activities.

5.41 Local authorities may find it useful to consider the Local Government Information Unit guide, Care and continuity: contingency planning for provider failure.

This section includes the following chapters:

6. Assessment and eligibility

This chapter provides guidance on:

This chapter covers:

Assessment

6.1 The assessment and eligibility process is one of the most important elements of the care and support system. The assessment is one of the key interactions between a local authority and an individual, whether an adult needing care or a carer. The process must be person-centred throughout, involving the person and supporting them to have choice and control.

6.2 The assessment process starts from when local authorities begin to collect information about the person, and will be an integral part of the person's journey through the care and support system as their needs change. It should not just be seen as a gateway to care and support, but should be a critical intervention in its own right, which can help people to understand their situation and the needs they have, to reduce or delay the onset of greater needs, and to access support when they require it. It can also help people to understand their strengths and capabilities, and the support available to them in the community and through other networks and services.

6.3 An 'assessment' must always be appropriate and proportionate. It may come in different formats and can be carried out in various ways, including but not limited to:

6.4 People may approach a local authority for an assessment, or be referred by a third party, for a number of reasons. The 'assessment' which they receive must follow the core statutory obligations, but the process is flexible and can be adapted to best fit with the person's needs, wishes and goals. The nature of the assessment will not always be the same for all people, and depending on the circumstances, it could range from an initial contact or triage process which helps a person with lower needs to access support in their local community, to a more intensive, ongoing process which requires the input of a number of professionals over a longer period of time.

6.5 The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. The outcome of the assessment is to provide a full picture of the individual's needs so that a local authority can provide an appropriate response at the right time to meet the level of the person's needs. This might range from offering guidance and information to arranging for services to meet those needs. The assessment may be the only contact the local authority has with the individual at that point in time, so it is critical that the most is made of this opportunity.

6.6 The assessment and eligibility process provides a framework to identify any level of need for care and support so that local authorities can consider how to provide a proportionate response at the right time, based on the individual's needs. Prevention and early intervention are placed at the heart of the care and support system, and even if a person has needs that are not eligible at that time, the local authority must consider providing information and advice or other preventative services. Local authorities must also consider the person's own strengths or if any other support might be available in the community to meet those needs. The assessment and eligibility framework provides for ongoing engagement with the person so where they have eligible needs they are involved in the arrangements put in place to deliver the outcomes they want to achieve.

6.7 To provide a comprehensive assessment, the assessor must be appropriately trained. Registered social workers and occupational therapists can provide important support and may be involved in complex assessments which indicate a wide range of needs, risks and strengths that may require a coordinated response from a variety of statutory and community services. Or they may be involved at the point of first contact to advise on whether preventative services would be more appropriate at that time.

6.8 Some of the duties and powers detailed in this chapter apply to children and young carers in transition as well as to adults (for more information on transition, (see chapter 16 on Transition to adult care and support).

The purpose of an assessment

6.9 The purpose of an assessment is to 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 assessment will support the determination of whether needs are eligible for care and support from the local authority, and understanding how the provision of care and support may assist the adult in achieving their desired outcomes. An assessment must be person-centred, involving the individual and any carer that the adult has, or any other person they might want involved. An adult with care needs could for example ask for their GP or a district nurse to be contacted to provide information relevant to their needs.

6.10 An assessment must seek to establish the total extent of needs before the local authority considers the person's eligibility for care and support and what types of care and support can help to meet those needs. This must include looking at the impact of the adult's needs on their wellbeing and whether meeting these needs will help the adult achieve their desired outcomes. The assessment process also provides the opportunity for local authorities to take a holistic view of the person's needs in the context of their wider support network. Local authorities must consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve.

6.11 An individual may be unable to request an assessment or may struggle to express their needs. The local authority must in these situations carry out supported decision making, helping the person to be as involved as possible in the assessment, and must carry out a capacity assessment. The requirements of the Mental Capacity Act and access to an Independent Mental Capacity Advocate apply for all those who may lack capacity.

6.12 Eligibility determinations must be made on the basis of an assessment, and cannot be made without having first carried out an assessment. Once an eligibility determination has been made, and the local authority has determined whether it will meet the person's needs (whether eligible or not), it must then carry out a financial assessment if it wishes to charge the adult and confirm that the adult is ordinarily resident in the authority. The eligibility determination cannot take place until an assessment has been completed, except in cases where the local authority is meeting urgent needs. The financial assessment may in practice run parallel to the needs assessment, but it must never influence an assessment of needs. Local authorities must inform individuals that a financial assessment will determine whether or not they pay towards their care and support, but this must have no bearing on the assessment process itself.

Needs assessment

6.13 Local authorities must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether or not the local authority thinks the individual has eligible needs or of their financial situation.

6.14 Wherever an individual expresses a need, or any challenges and difficulties they face because of their condition(s), the local authority should ensure that it has established the impact of that on the individual's day-to-day life. The local authority must also consider whether the individual's needs impact upon their wellbeing beyond the ways identified by the individual. For example where an adult expresses a need regarding their physical condition and mobility, the local authority must establish the impact of this on the adult's desired outcomes; and must also consider whether their need(s) have further consequences on their wider wellbeing such as on their personal health or the suitability of their living accommodation.

6.15 During the assessment, local authorities must consider all of the adult's care and support needs, regardless of any support being provided by a carer. Where the adult has a carer, information on the care that they are providing can be captured during assessment, but it must not influence the eligibility determination. After the eligibility determination has been reached, if the needs are eligible or the local authority otherwise intends to meet them, the care which a carer is providing can be taken into account during the care and support planning stage. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. This ensures that the entirety of the adult's needs are identified and the local authority can respond appropriately if the carer feels unable or unwilling to carry out some or all of the caring they were previously providing.

Carer's assessment

6.16 Where an individual provides or intends to provide care for another adult and it appears that the carer may have any level of needs for support, local authorities must carry out a carer's assessment. Where an adult provides care under contract (for example, for employment) or as part of voluntary work, they should not normally be regarded as a carer, and so the local authority would not be required to carry out the assessment.

6.17 There may be circumstances where the adult providing care, either under contract or through voluntary work, is also providing care for the same adult outside of those arrangements. In such a circumstance, the local authority must consider whether to carry out a carer's assessment for that part of the care they are not providing on a contractual or voluntary basis. There may also be cases where the person providing care does so as voluntary work or under contract, but the nature of their relationship with the person cared for is such that they ought to be considered as a carer within the scope of the Act. The local authority has the power to carry out an assessment in such cases, if it judges that there is reason to do so.

6.18 Carers' assessments must seek to establish not only the carer's needs for support, but also the sustainability of the caring role itself, which includes both the practical and emotional support the carer provides to the adult. Therefore, where the local authority is carrying out a carer's assessment, it must include in its assessment a consideration of the carer's potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. Some carers may need support in recognising issues around sustainability, and in recognising their own needs. This will allow local authorities to make a realistic evaluation of the carer's present and future needs for support and whether the caring relationship is sustainable. Where appropriate these views should be sought in a separate conversation independent from the adult's needs assessment.

6.19 The carer's assessment must also consider the outcomes that the carer wants to achieve in their daily life, their activities beyond their caring responsibilities, and the impact of caring upon those activities. This includes considering the impact of caring responsibilities on a carer's desire and ability to work and to partake in education, training or recreational activities, such as having time to themselves. This impact should be considered in both a short-term immediate sense but also the impact of caring responsibilities over a longer term, cumulative sense.

Refusal of assessment

6.20 An adult with possible care and support needs or a carer may choose to refuse to have an assessment. The person may choose not to have an assessment because they do not feel that they need care or they may not want local authority support. In such circumstances local authorities are not required to carry out an assessment. However, where the local authority identifies that an adult lacks mental capacity and that carrying out a needs assessment would be in the adult's best interests, the local authority is required to do so. The same applies where the local authorities identifies that an adult is experiencing, or is at risk of experiencing, abuse or neglect. Where the adult who is or is at risk of abuse or neglect has capacity and is still refusing an assessment, local authorities must undertake an assessment so far as possible and document this. They should continue to keep in contact with the adult and carry out an assessment if the adult changes their mind, and asks them to do so.

6.21 In instances where an individual has refused a needs or carer's assessment but at a later time requests that an assessment is carried out, the local authority must do so. Additionally, where an individual previously refused an assessment and the local authority establishes that the adult or carer's needs or circumstances have changed, the local authority must consider whether it is required to offer an assessment, unless the person continues to refuse.

6.22 The assessment process starts from when local authorities start to collect information about the person. From their very first contact with the local authority, the person must be given as much information as possible about the assessment process, as early as possible, to ensure a personalised approach to the assessment. This should include detail of what can be expected during the assessment process (such as the format and timescale of assessment, complaints processes and possible access to independent advocacy) and allow them to be as involved in the process as possible. Local authorities must ensure that this information is in an accessible format for those to whom it is provided. For example, Braille may be an appropriate format for many with partial-sightedness or who are blind. Some formats are less accessible for certain groups, such as online platforms for those with particular sensory impairments.

6.23 From this early stage local authorities should consider whether the individual would have substantial difficulty in being involved in the assessment process and if so consider the need for independent advocacy (see chapter 7). Local authorities should also consider whether the person may have difficulty communicating (for example those with Autistic Spectrum Disorder or Profound and Multiple Learning Disabilities) and whether a specialist or interpreter may be needed to support communication. For information on reasonable adjustments, see the Equality Act 2010

6.24 Getting the initial response right can save time and costs on assessment later. Some local authorities have found that putting in place a single access point for all new requests and people currently receiving care can speed up and simplify the process for people approaching the authority; and can also free up time for professional staff to focus on more complex cases.

6.25 Local authorities should not, however, remove people from the process too early. Early or targeted interventions such as universal services, a period of reablement and providing equipment or minor household adaptions can delay an adult's needs from progressing. The first contact with the authority, which triggers the requirement to assess, may lead to a pause in the assessment process to allow such interventions to take place and for any benefit to the adult to be determined. Local authorities must ensure that their staff are sufficiently trained and equipped to make the appropriate judgements needed to steer individuals seeking support towards information and advice, preventative services or a more detailed care and support assessment, or all of these. They must also be able to identify a person who may lack mental capacity and to act accordingly.

6.26 The Care Act provides local authorities with the powers to meet urgent needs where they have not completed an assessment. Authorities may meet urgent need for care and support regardless of the person's ordinary residence. See the Care Act 2014, Section 19. Where an individual with urgent needs approaches or is referred to the local authority, the local authority should provide an immediate response and meet the individual's care and support needs. For example, where an individual's condition deteriorates rapidly or they have an accident, they will need a swift response to ensure their needs are met. In some cases, the appropriate response may be that the local authority will meet the adult's needs. In other cases, an immediate referral may be the best way to meet a person's urgent needs, for example by completing the NHS Continuing Healthcare Fast Track Pathway Tool. Following this initial response, the individual should be informed that a more detailed needs assessment, and any subsequent processes, will follow. Once the local authority has ensured these urgent needs are met, it can then consider details such as the person's ordinary residence and finances.

6.27 Staff who are involved in this first contact must have the appropriate training and should have the benefit of access to professional support from social workers, occupational therapists and other relevant experts as appropriate, to support the identification of any underlying conditions or to ensure that complex needs are identified early and that people are signposted appropriately.

6.28 Local authorities must ensure that any adult with an appearance of care and support needs, and any carer with an appearance of need for support, receives a proportionate assessment which identifies their level of needs. Where appropriate, an assessment may be carried out over the phone or online. In adopting such approaches, local authorities should consider whether the proposed means of carrying out the assessment poses any challenges or risks for certain groups, particularly when assuring itself that it has fulfilled its duties around safeguarding, independent advocacy, and assessing mental capacity. Where there is concern about a person's capacity to make a decision, for example as a result of a mental impairment such as those with dementia, acquired brain injury, learning disabilities or mental health needs, a face-to-face assessment should be arranged. Local authorities have a duty of care to carry out an assessment in a way that enables them to recognise the needs of those who may not be able to put these into words. Local authorities must ensure that assessors have the skills, knowledge and competence to carry out the assessment in question, and this applies to all assessments regardless of the format they take.

6.29 An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.

Supporting the person's involvement in the assessment

6.30 Putting the person at the heart of the assessment process is crucial to understanding the person's needs, outcomes and wellbeing, and delivering better care and support. The local authority must involve the person being assessed in the process as they are best placed to judge their own wellbeing. In the case of an adult with care and support needs, the local authority must also involve any carer the person has (which may be more than one carer), and in all cases, the authority must also involve any other person requested. The local authority should have processes in place, and suitably trained staff, to ensure the involvement of these parties, so that their perspective and experience supports a better understanding of the needs, outcomes and wellbeing.

6.31 Where local authorities identify that an adult is unable to engage effectively in the assessment process independently, it should seek to involve somebody who can assist the adult in engaging with the process and helping them to articulate their preferred outcomes and needs as early as possible. This will include some people with mental impairments who will nevertheless have capacity to engage in the assessment alongside the local authority. They may require assistance whereby the local authority provides an assessment, tailored to their circumstances, their needs and their ability to engage. They should be supported in understanding the assessment process and assisted to make decisions wherever possible.

6.32 Where there is concern about a person's capacity to make a specific decision, for example as a result of a mental impairment such as dementia, acquired brain injury or learning disabilities, then an assessment of capacity should be carried out under the Mental Capacity Act ( MCA). Those who may lack capacity will need extra support to identify and communicate their needs and make subsequent decisions, and may need an Independent Mental Capacity Advocate. The more serious the needs, the more support people may need to identify their impact and the consequences. Professional qualified staff, such as social workers, can advise and support assessors when they are carrying out an assessment with a person who may lack capacity.

Independent advocates

6.33 At the point of first contact, request or referral (including self-referral), local authorities must seek to ascertain whether an individual is able to be involved in their assessment and local authorities must therefore consider whether the individual has substantial difficulty in doing so. Local authorities must consider whether the adult would experience substantial difficulty in any of these 4 areas: understanding the information provided; retaining the information; using or weighing up the information as part of the process of being involved; and communicating the person's views, wishes or feelings. Where a person has substantial difficulty in any of these 4 areas, then they need assistance (see chapter 7, on independent advocacy).

6.34 If a person does have substantial difficulty, the local authority must find someone appropriate and independent to support and represent the person, for the purpose of facilitating their involvement. This should be done as early as possible in the assessment process so that the individual's involvement can be supported throughout all stages of the process. Individuals may require help to understand information provided, assistance in weighing up the information, and support in communicating their wishes and preferences. Where there is a family member or friend who is willing and able to facilitate the person's involvement effectively, and who is acceptable to the individual and judged appropriate by the local authority, they may be asked to support the individual in the assessment process. Where there is no one thought to be appropriate for this role - either because there is no family member or friend willing and available, or if the individual does not want them to be a part of the assessment - the local authority must appoint an independent advocate.

Appropriate and proportionate assessments

6.35 The assessment must be person-centred throughout. Local authorities must find out the extent to which the person being assessed wishes to be involved in the assessment and should meet those wishes as far as is practicable do so, as the person is best placed to understand the impact of their condition(s) on their outcomes and wellbeing.

6.36 An assessment should be a collaborative process and it is therefore essential that the process is transparent and understandable so that the individual is able to:

6.37 To support the person's involvement, the local authority should establish the individual's communication needs and seek to adapt the assessment process accordingly. In doing so local authorities must provide information about the assessment process in an accessible format.

6.38 To help the adult with needs for care and support, or the carer, prepare for the assessment the local authority should provide in advance, and in an accessible format, the list of questions to be covered in the assessment. This will help the individual or carer prepare for their assessment and think through what their needs are and the outcomes they want to achieve.

6.39 Some people being assessed may have severe communication needs, such as people with Profound and Multiple Learning Disabilities, Autistic Spectrum Disorder, or those who are deaf or blind. Such individuals may require the support of a specialist interpreter to help them to communicate and engage in the assessment.

6.40 Local authorities should also consider the impact of the assessment process itself on the individual's condition(s). People may feel uncertain and worried about what an assessment involves and may find the process itself to be strenuous. Local authorities should therefore give consideration to the preferences of the individual with regards to the timing, location and medium of the assessment.

6.41 The assessment should be designed to reflect the wishes of the person being assessed, taking into account their presenting need and their circumstances. An assessment process which benefits an individual in one instance may not necessarily be as effective for another. Local authorities should recognise this and in order to maintain a person-centred approach, local authorities must ensure that assessments are flexible to each individual case.

6.42 In carrying out a proportionate assessment local authorities must have regard to:

a) The person's wishes and preferences and desired outcomes. For example, an individual who pays for their own care may wish to receive local authority support with accessing a particular service, but may not want the same interaction with the authority as someone who wants greater support.

b) The severity and overall extent of the person's needs. For example, an individual with more complex needs will require a more detailed assessment, potentially involving a number of professionals. A person with lower needs may require a less intensive response.

c) The potential fluctuation of a person's needs, both adults and carers. For example, where the local authority is aware that an adult's needs fluctuate over time, the assessment carried out at a particular moment may take into account the adult's history to get a complete picture of the person's needs.

6.43 Each local authority may decide to use an assessment tool to help collect information about the adult or carer and details of their wishes and feeling and their desired outcomes and needs. Where a local authority has decided that a person does not need a more detailed assessment, it should consider which elements of the assessment tool it should use and which are not necessary. When carrying out a proportionate assessment the assessor should continue to look for the appearance of further needs which may be the result of an underlying condition. Where the assessor believes that the person's presenting needs may be as a result of or a part of wider needs then the local authority should undertake a more detailed assessment and refer the person to other services such as housing or the NHS if necessary. For example, the Brain Injury Rehabilitation Trust has produced the Brain Injury Needs Indicator, which is a tool that can be used as part of the assessment to help identify deficits of people with a suspected or diagnosed acquired brain injury.

Supported self-assessment

6.44 A supported self-assessment is an assessment carried out jointly by the adult with care and support needs or carer and the local authority. It places the individual in control of the assessment process to a point where they themselves complete their assessment form. Whilst it is the person filling in the assessment form, the duty to assess the person's needs, and in doing so ensure that they are accurate and complete, remains with the local authority. Local authorities can offer individuals a supported self-assessment, and must do so if the adult or carer is able, willing and has capacity to undertake it. If the person does not wish to self-assess, then the local authority must undertake an assessment following one of the other processes outlined above.

6.45 In order to support the person in carrying out a supported self-assessment, the local authority must give them any relevant information it has either about the person themselves or, for a carer's self-assessment, about the individual they care for. This is so that the person undertaking the assessment has a full picture of their care and support history and is equipped with the same information an assessor would have when undertaking an assessment. Before sharing any information, the local authority must ensure that the person consents to that information being shared. If the person lacks capacity, information must only be shared where the local authority is satisfied that doing so is in the person's best interests. In the case of a young carer, the local authority must also consider whether it is appropriate to share the information about the person the young carer cares for (see chapter 16).

6.46 Once the person has completed the assessment, the local authority must ensure that it is an accurate and complete reflection of the person's needs, outcomes, and the impact of needs on their wellbeing. The process of a supported self-assessment begins with first contact and is only complete when this assurance has been secured. Until the process of assurance is complete and the local authority has ensured that it is accurate, it will not have discharged its duties under section 9 of the Care Act. Where the person carrying out a supported self-assessment jointly with the local authority requires a specialist, for example people who are deafblind, then the professional leading this assurance process must be seen as the 'assessor' and so must have specific training and expertise relating to the individual's needs. When assuring itself that a self-assessment is comprehensive a local authority should not look to repeat the full assessment process again.

6.47 In assuring self-assessments local authorities may consider it useful to seek the views of those who are in regular contact with the person self-assessing, such as their carer(s) or other appropriate people from their support network, and any professional involved in providing care such as a housing support officer, a GP, a treating clinician, a district nurse, a rehabilitation officer or relevant prison staff. In doing this, the local authority should first seek the person's consent. This may be helpful in allowing local authorities to build an understanding of the individual's desires, outcomes, needs, and the impact on their wellbeing.

6.48 The person should be asked to complete a similar assessment questionnaire that the authority uses in their needs or carers' assessments, which must assess the person's needs, their outcomes, and the impact of their needs on their wellbeing. The assessment questionnaire can be the same as the one used by local authority assessors or adapted to cover the same questions but made easier for the person to use and understand. Local authorities must also ensure they fulfil other relevant duties under the Act when supporting and assuring a person's self-assessment, such as those around independent advocacy. If at any point the local authority suspects that a person is experiencing, or is at risk of, abuse and neglect, it must begin a safeguarding enquiry (see chapter 14).

6.49 Before offering a supported self-assessment local authorities must ensure that the individual has capacity to fully assess and reflect their own needs. Local authorities must establish the individual's mental capacity in accordance with the Mental Capacity Act.

6.50 If a local authority considers a person may lack capacity to understand and carry out a self-assessment, they must carry out a capacity assessment. If this shows that the person lacks the capacity to carry out a self-assessment, then the self-assessment should not be offered.

6.51 Where local authorities have established that the adult has capacity to undertake a self-assessment but experiences substantial difficulty in understanding, retaining and using the relevant information in relation to their self-assessment, they may wish to involve their carer or any other member of their family or support network in their self-assessment. Where the adult does not have the support required from a carer or family member who is willing and able to facilitate the person's involvement effectively and who is acceptable to the individual and judged appropriate by the local authority, the local authority must provide an independent advocate to assist them in their self-assessment. When a person who would otherwise receive a specialist assessment (for example, someone who is deafblind) chooses to undertake a self-assessment, the local authority must involve a person who has specific training and expertise when assuring that the person's assessment taken as a whole reflects the overall needs of the individual concerned.

6.52 Local authorities should ensure that self-assessments are completed in suitable time periods. If there is a delay in the person returning the self-assessment form the authority should assure itself that this is not because the person's condition(s) have deteriorated and is unable to complete the self-assessment.

6.53 The local authority, once it has assured itself that the self-assessment has accurately captured the person's needs, must make an eligibility determination. Where appropriate this may include taking into account the person's own view. Although the local authority and the individual are working jointly to ascertain needs and eligibility, the final decision regarding eligibility will rest with the local authority. In all cases, the authority must inform the person of their eligibility judgement and why the local authority has reached the eligibility determination that it has. It must also discuss what needs are eligible and discuss how these might be met. Where the authority determines that the person has needs that are not eligible it must provide advice and information on what services are available in the community that can support the person in meeting those needs.

Safeguarding

6.54 Where a person is at risk of abuse or neglect, it is important that local authorities act swiftly and put in place an effective response. When carrying out an assessment local authorities must consider the impact of the adult's needs on their wellbeing. If it appears to local authorities that the person is experiencing, or at risk of, abuse or neglect, they must carry out a safeguarding enquiry and decide with the adult in question what action, if any, is necessary and by whom (see chapter 14).

6.55 The decision to carry out a safeguarding enquiry does not depend on the person's eligibility, but should be taken wherever there is reasonable cause to think that the person is experiencing, or is at risk of, abuse or neglect. Where this is the case, a local authority must carry out (or request others to carry out) whatever enquiries it thinks are necessary in order to decide whether any further action is necessary.

6.56 Where the actions required to protect the adult can be met by local authorities, they should take appropriate action. In some cases, safeguarding enquiries may result in the provision of care and support (under either section 18 or 19 of the Care Act), or the provision of preventative services (under section 2) or information and advice (under section 4). In the majority of cases the response will involve other agencies, for example, a safeguarding enquiry may result in referrals to the police, a change of accommodation, or action by CQC.

6.57 Where the adult has care and support needs, local authorities must continue to carry out a needs assessment and determine whether they have eligible needs, and if so, how these will be met. The assessment for care and support should run parallel to the safeguarding enquiry and the enquiry should not disrupt the assessment process or the local authority meeting eligible needs.

Fluctuating needs

6.58 As the condition(s) of the individual at the time of the assessment may not be entirely indicative of their needs more generally, local authorities must consider whether the individual's current level of need is likely to fluctuate and what their on-going needs for care and support are likely to be. This is the case both for short-term fluctuations, which may be over the course of the day, and longer term changes in the level of the person's needs. In establishing the on-going level of need local authorities must consider the person's care and support history over a suitable period of time, both the frequency and degree of fluctuation. The local authority may also take into account at this point what fluctuations in need can be reasonably expected based on experience of others with a similar condition. It is important to recognise the benefit of adopting this comprehensive approach to assessment as the consideration of an individual's wider wellbeing may allow local authorities to provide types of care and support, or information and advice which delay or prevent the development of further needs in the future.

6.59 The assessment should also include a consideration of the individual's wider care and support needs. This may include types of care and support the individual has received in the past and their general medical history, which may be indicative of their current care and support needs.

Focusing on preventing needs

6.60 The assessment and eligibility framework should be a key element of any prevention strategies authorities put in place. It is during the assessment where local authorities can identify needs that could be reduced, or where escalation could be delayed, and help people improve their wellbeing by providing specific preventive services, or information and advice on other universal services available locally. Early interventions can prevent or delay a person's needs from progressing.

6.61 In parallel with assessing a person's needs, local authorities must consider the benefits of approaches which delay or prevent the development of needs in individuals. This applies to both people with current needs that may be reduced or met through available universal services in the community, and those without needs who may otherwise require care and support in the future. This could include directing people to services such as community support groups which ensure that people feel supported, including an ability to participate in their local community. It may also include helping the person to access services which the local authority provides as part of its universal offer on prevention. Local authorities can also support the person in understanding other types of support available to them, such as within their own support networks, for example to seek to promote access to appropriate employment, education or training, which can be an effective way of maintaining independence. Such interventions at an early stage will help to sustain the independence and wellbeing of people (see chapter 2 on prevention and chapter 3 on information and advice).

6.62 Where the local authority judges that the person may benefit from such types of support, it should take steps to support the person to access those services. The local authority may 'pause' the assessment process to allow time for the benefits of such activities to be realised, so that the final assessment of need (and determination of eligibility) is based on the remaining needs which have not been met through such interventions. For example, if the local authority believes that a person may benefit from a short-term reablement service which is available locally, it may put that in place and complete the assessment following the provision of that service.

Considering the person's strengths and capabilities

6.63 At the same time as carrying out the assessment, the local authority must consider what else other than the provision of care and support might assist the person in meeting the outcomes they want to achieve. In considering what else might help, authorities should consider the person's own strengths and capabilities, and what support might be available from their wider support network or within the community to help. Strengths-based approaches might include co-production of services with people who are receiving care and support to foster mutual support networks. Encouraging people to use their gifts and strengths in a community setting could involve developing residents' groups and appropriate training to support people in developing their skills.

6.64 Local authorities might also consider the ways a person's cultural and spiritual networks can support them in meeting needs and building strengths, and explore this with the person. Any suggestion that support could be available from family and friends should be considered in light of their appropriateness, willingness and ability to provide any additional support and the impact on them of doing so. It must also be based on the agreement of the adult or carer in question.

Considering the person's strengths: a case study

Whole family approach

6.65 The intention of the whole family approach is for local authorities to take a holistic view of the person's needs and to identify how the adult's needs for care and support impact on family members or others in their support network.

6.66 During the assessment the local authority must consider the impact of the person's needs for care and support on family members or other people the authority may feel appropriate. This will require the authority to identify anyone who may be part of the person's wider network of care and support.

6.67 In considering the impact of the person's needs on those around them, the local authority must consider whether or not the provision of any information and advice would be beneficial to those people they have identified. For example, this may include signposting to any support services in the local community.

6.68 The local authority must also identify any children who are involved in providing care. The authority may become aware that the child is carrying out a caring role through the assessment of the person needing care or their carer, or informed through family members or a school. Identification of a young carer in the family should result in an offer of a needs assessment for the adult requiring care and support and, where appropriate, the local authority must consider whether the child or young carer should be referred for a young carer's assessment or a needs assessment under the Children Act 1989, or a young carer's assessment under section 63 of the Care Act. Local authorities should ensure that adults' and children's care and support services work together to ensure the assessment is effective - for example by sharing expertise and linking processes.

6.69 When carrying out an adult's or carer's assessment, if it appears that a child is involved in providing care the local authority must consider:

the impact of the person's needs on the young carer's wellbeing, welfare, education and development

whether any of the caring responsibilities the young carer is undertaking are inappropriate

6.70 An assessment should take into account the parenting responsibilities of the person as well as the impact of the adult's needs for care and support on the young carer.

6.71 Local authorities must also consider whether any of the caring tasks the child is undertaking are inappropriate. They should consider how supporting the adult with needs for care and support can prevent the young carer from undertaking excessive or inappropriate care and support responsibilities. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing or their prospects in education and life. This might include:

6.72 Inappropriate caring responsibilities should be considered as anything which is likely to have an impact on the child's health, wellbeing or education, or which can be considered unsuitable in light of the child's circumstances and may include:

6.73 When a local authority is determining whether the tasks a child carries out are inappropriate, it should also take into account the child's own view wherever appropriate.

Combining assessments

6.74 Local authorities may combine an assessment of an adult needing care and support or of a carer with any other assessment it is carrying out either of that person or another where both the individual and carer agree, and the consent condition is met in relation to a child. This will also avoid the authority carrying out 2 separate assessments when the 2 assessments are intrinsically linked. If either of the individuals concerned does not agree to a combined assessment, then the assessments must be carried out separately.

Integrated assessments

6.75 People may have needs that are met by various bodies. Therefore, a holistic approach to assessment which aims to bring together all of the person's needs may need the input of different professionals such as adult care and support, children's services, housing, experts in the voluntary sector, relevant professionals in the criminal justice system, health or mental health professionals.

6.76 A local authority may carry out a needs or carer's assessment jointly with another body carrying out any other assessment in relation to the person concerned, provided that person agrees. In doing so, the authority may integrate or align assessment processes in order to better fit around the needs of the individual. An integrated approach may involve working together with relevant professionals on a single assessment. It may also include putting processes in place to ensure that the person is referred for other assessments such as an assessment for after-care needs under the Mental Health Act 1983. In some settings, for example in prisons, local authorities should engage relevant professionals early to ensure assessors are prepared for carrying out an assessment in that environment.

6.77 Where more than one agency is assessing a person, they should all work closely together to prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing.

6.78 Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high quality, coordinated assessment. To achieve this, local authorities should:

shape the process around the person, involving the person and considering their experience when coordinating an integrated assessment

work with other professionals to ensure the person's health and care services are aligned. This will require flexibility of systems where possible, for example when sharing information. It will also be strengthened by a culture of common values and objectives at frontline level - joint visits can be helpful here

link together various care and support plans to set out a single, shared care pathway, for example when following the Care Programme Approach for people with a severe mental disorder who need multi-agency support or intensive intervention, under the direction of a named care coordinator. See chapter 34 of the revised Code of Practice Mental Health Act 1983. A multi-agency approach is particularly important where people are enrolled on the Proactive Care Programme, which was introduced through the Avoiding Unplanned Emergency Admissions Enhanced Service in the 2014 to 2015 GP Contract.

6.79 The local authority may carry out the care and support assessment jointly with any other assessment, and can also undertake the other assessment on behalf of the other body, where this is agreed. Where an assessment involves a body from outside of the local authority, the local authority should provide any resources or facilities which may be required to carry out the assessment. Sharing resources may include the provision of facilities or relative information relating to the person being assessed. (See chapters 15-18 on Integration and Partnership Working).

NHS Continuing Healthcare

6.80 Where it appears that a person may be eligible for NHS Continuing Healthcare ( NHS CHC), local authorities must notify the relevant Clinical Commissioning Group ( CCG). NHS CHC is a package of on-going care that is arranged and funded solely by the NHS where the individual has been found to have a 'primary health need' as set out in the national framework for NHS Continuing Healthcare and NHS-funded nursing care. Such care is provided to individuals aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. Eligibility for NHS CHC places no limits on the settings in which the package of support can be offered or on the type of service delivery.

6.81 Whilst local authorities have a duty to carry out an assessment where a person has an appearance of needs and a duty to meet eligible needs, local authorities cannot arrange services that are the responsibility of the NHS (for example, care provided by registered nurses and services that the NHS has to provide because the individual is eligible for NHS CHC). However, the local authority may provide or arrange healthcare services where they are incidental or ancillary to doing something else to meet needs for care and support and the service or facility in question is of a nature that a local authority could be expected to provide. Ultimate responsibility for arranging and monitoring the services required to meet the needs of those who qualify for NHS CHC rests with the NHS.

6.82 Individuals may require care and support provided by their local authority and/or services arranged by CCGs. Local authorities and CCGs therefore have a responsibility to ensure that the assessment of eligibility for care and support and CHC respectively take place in a timely and consistent manner. If, following an assessment for NHS CHC, a person is not found to be eligible for NHS CHC, the NHS may still have a responsibility to contribute to that person's health needs - either by directly commissioning services or by part-funding the package of support. Where a package of support is commissioned or funded by both a local authority and a CCG, this is known as a joint package of care. A joint package of care could include NHS-funded nursing care and other NHS services that are beyond the powers of a local authority to meet. The joint package could also involve the CCG and the local authority both contributing to the cost of the care package, or the CCG commissioning part of the package. Joint packages of care may be provided in a nursing or care home, or in a person's own home, and could be by way of joint personal budget.

6.83 Local authorities and CCGs in each local area must agree a local disputes resolution process to resolve cases where there is a dispute between them about eligibility for NHS CHC, the apportionment of funding in joint funded care and support packages, or the operation of refunds guidance. Disputes should not delay the provision of the care package, and the process should make clear how funding will be provided pending resolution of the dispute. Where disputes relate to local authorities and CCGs in different geographical areas, the disputes resolution process of the responsible CCG should normally be used in order to ensure resolution in a robust and timely manner. This should include agreement on how funding will be provided during the dispute, and arrangements for reimbursement to the agencies involved once the dispute is resolved.

Roles and responsibilities

6.84 Assessments can be carried out by a range of professionals including registered social workers, occupational therapists and rehabilitation officers. Registered social workers and occupational therapists are considered to be 2 of the key professions in adult care and support. Local authorities should consider how adults who need care, carers, and assessors have access to registered social care practitioners, such as social workers or occupational therapists.

Training

6.85 It is essential that the assessment is carried out to the highest quality. The assessment must: identify the person's needs, outcomes and how these impact on their wellbeing; consider the person's strengths and capabilities; and consider what universal services might help the person improve their wellbeing. Local authorities must ensure that their staff have the required skills, knowledge and competence to undertake assessments and that this is maintained. This applies no matter how the assessment is carried out, including first contact, any assessment over the phone or online, or self-assessments where the person carrying out the assurance will need to have the appropriate training.

6.86 Local authorities must ensure that assessors are appropriately trained and competent whenever they carry out an assessment. This means ensuring that assessors undergo regular, up-to-date training on an ongoing basis. The training must be appropriate to the assessment, both the format of assessment and the condition(s) and circumstances of the person being assessed. They must also have the skills and knowledge to carry out an assessment of needs that relate to a specific condition or circumstances requiring expert insight, for example when assessing an individual who has autism, learning disabilities, mental health needs or dementia. This training must be maintained throughout their career. As part of maintaining their registration, social workers and occupational therapists are required to evidence their Continuing Professional Development.

6.87 When assessing particularly complex or multiple needs, an assessor may require the support of an expert to carry out the assessment, to ensure that the person's needs are fully captured. Local authorities should consider whether additional relevant expertise is required on a case-by-case basis, taking into account the nature of the needs of the individual, and the skills of those carrying out the assessment. The local authority must ensure that the person is able to be involved as far as possible, for example by providing an interpreter where a person has a particular condition affecting communication - such as autism, blindness, or deafness. See the Equality Act for necessary provisions around reasonable adjustments.

6.88 Where the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise. This is to ensure that the assessor can ask the right questions relating to the condition and interpret these appropriately to identify underlying needs. A person with relevant expertise can be considered as somebody who, either through training or experience, has acquired knowledge or skill of the particular condition or circumstance. Such a person may be a doctor or health professional, or an expert from the voluntary sector, but there is no obligation for the local authority to source an expert from an outside body if the expertise is available in house.

6.89 The Department of Health has published guidance for certain groups of adults that refer to their assessment for care and support. Two specific areas are for people who are deafblind and people with autism and these pieces of guidance should be read with this guidance. Think Autism 2014, the April 2014 update to Fulfilling and Rewarding Lives, the strategy for adults with autism in England (2010), sets out that local authorities should:

6.90 The Care Act strengthens this guidance in relation to assessors having specialised training to assess an adult with autism. The Act places a legal requirement on local authorities that all assessors must have the skills, knowledge and competence to carry out the assessment in question. Where an assessor does not have experience in a particular condition (such as autism, learning disabilities, mental health needs or other conditions), they must consult someone with relevant experience. This is so that the person being assessed is involved throughout the process and their needs, outcomes and the impact of needs on their wellbeing are all accurately identified.

Assessment for people who are deafblind

6.91 Local authorities must ensure that an expert is involved in the assessment of adults who are deafblind, including where a deafblind person is carrying out a supported self-assessment jointly with the authority. People are regarded as deafblind 'if their combined sight and hearing impairment causes difficulties with communication, access to information and mobility. This includes people with a progressive sight and hearing loss' (Think Dual Sensory, Department of Health, 1995).

6.92 During an assessment if there is the appearance of both sensory impairments, even if when taken separately each sensory impairment appears relatively mild, the assessor must consider whether the person is deafblind as defined above. If a person is deafblind, this must trigger a specialist assessment. This specialist assessment must be carried out by an assessor or team that has training of at least QCF or OCN level 3, or above where the person has higher or more complex needs.

6.93 Training and expertise should in particular include; communication, one-to-one human contact, social interaction and emotional wellbeing, support with mobility, assistive technology and rehabilitation. The type and degree of specialism required should be judged on a case by case basis, according to the extent of the person's condition and their communication needs. Local authorities should also recognise that deafblindness is a dual sensory condition which requires a knowledge and understanding of the 2 respective conditions in unison, which cannot be replicated by taking an individual approach to both senses.

6.94 The combined loss of sight and hearing can have a significant impact upon the individual even where they are not profoundly deaf and totally blind, as it is the impact of one impairment upon the other which causes difficulties. Deafblindness can have significant impact on the adult's independence and their ability to achieve their desired outcomes. In particular deafblindness may have impact on the adult's:

6.95 Local authorities should recognise that adults may not define themselves as deafblind. Instead they may describe their vision and hearing loss in terms which indicate that they have significant difficulty in their day-to-day lives. The assessment must therefore take the initiative to establish maximum possible communication with the adult to ensure that individuals are as fully engaged as possible and have the opportunity to express their wishes and desired outcomes. This is particularly important where the person is carrying out a supported self-assessment jointly with the local authority. The person ensuring that the self-assessment is a complete and accurate reflection of needs must have specific training and expertise that will enable maximum possible communication and an accurate and complete assessment.

6.96 Whilst the person carrying out the assessment must have the suitable training and expertise, it may not be possible for them to carry out the assessment without an interpreter, for instance where the adult uses sign language. Therefore, where necessary a qualified interpreter with training appropriate for the deafblind adult's communication should be used. It is not normally appropriate to use a family member or carer as an interpreter, though sometimes this is appropriate, for instance where the adult's communication is idiosyncratic or personal to them and would only be understood by those close to them. This should only take place where the adult agrees or - if they lack capacity - where it is in their best interests.

6.97 The assessment should take into account both the current and future needs of the person being assessed, particularly where the adult's deafblindness is at risk of deteriorating. In such cases the adult may benefit from learning alternative forms of communication before their condition has deteriorated to a point where their current or preferred form of communication is no longer suitable.

Record keeping

6.98 Following their assessment, individuals must be given a record of their needs or carer's assessment. A copy must also be shared with anybody else that the individual requests the local authority to share a copy with. Where an independent advocate, an Independent Mental Capacity Advocate or an Independent Mental Health Advocate is involved in supporting the individual, the local authority should keep the advocate informed so that they can support the person to understand the outcome of the assessment and its implications.

Delegating assessments

6.99 Local authorities can delegate the majority of their care and support functions, including assessment (see chapter 18). In doing so they must ensure that the body carrying out an assessment complies with all the requirements and fulfils all relevant duties under the Act and regulations (such as providing an independent advocate - (see chapter 7). Anything done by the body carrying out an assessment is treated as if done by the local authority. In respect of duties surrounding non-delegated functions, such as safeguarding (see chapter 14), local authorities must have appropriate processes in place to ensure they fulfill these functions, for example agreeing with the body that the local authority is notified if a safeguarding issue is spotted.

Eligibility

6.100 The national eligibility criteria set a minimum threshold for adult care and support needs and carer support needs which local authorities must meet. All local authorities must comply with this national threshold. Authorities can also decide to meet needs that are not deemed to be eligible if they chose to do so.

6.101 The introduction of a national eligibility threshold provides more transparency on what level of need is eligible. More clarity will support authorities in deciding whether the earlier provision of information and advice or preventative services would delay a person from developing needs which meet the eligibility criteria or whether longer-term care and support might be needed. It should also help the person needing care or their carer to think more broadly about what support might be available in the local community or through their support network to meet their needs and support the outcomes they want to achieve.

What is the national eligibility threshold for adults needing care?

6.102 The eligibility threshold for adults with care and support needs is set out in the Care and Support (Eligibility Criteria) Regulations 2015 (the 'Eligibility Regulations'). The threshold is based on identifying how a person's needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.

6.103 In considering whether an adult with care and support needs has eligible needs, local authorities must consider whether:

An adult's needs are only eligible where they meet all 3 of these conditions.

Interpreting the eligibility criteria

6.104 The adult's needs arise from or are related to a physical or mental impairment or illness. The first condition that local authorities must be satisfied about is that the adult's needs for care and support are due to a physical or mental impairment or illness and that they are not caused by other circumstantial factors. Local authorities must consider at this stage if the adult has a condition as a result of either physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury. The authority should base their judgment on the assessment of the adult and a formal diagnosis of the condition should not be required.

As a result of the adult's needs, the adult is unable to achieve 2 or more of the outcomes set out in the regulations

6.105 The second condition that authorities must consider is whether the adult is 'unable' to achieve 2 or more of the outcomes set out in the regulations. Authorities must also be aware that the regulations provide that 'being unable' to achieve an outcome includes any of the following circumstances, where the adult:

6.106 The Eligibility Regulations set out a range of outcomes. Local authorities must consider whether the adult is unable to achieve 2 or more of these outcomes when making the eligibility determination. The following section of the guidance provides examples of how local authorities should consider each outcome set out in the Eligibility Regulations (which do not constitute an exhaustive list) when determining the adult's eligibility for care and support:

a) Managing and maintaining nutrition - local authorities should consider whether the adult has access to food and drink to maintain nutrition, and that the adult is able to prepare and consume the food and drink.

b) Maintaining personal hygiene - local authorities should, for example, consider the adult's ability to wash themselves and launder their clothes.

c) Managing toilet needs - local authorities should consider the adult's ability to access and use a toilet and manage their toilet needs.

d) Being appropriately clothed - local authorities should consider the adult's ability to dress themselves and to be appropriately dressed, for instance in relation to the weather to maintain their health.

e) Being able to make use of the home safely - local authorities should consider the adult's ability to move around the home safely, which could for example include getting up steps, using kitchen facilities or accessing the bathroom. This should also include the immediate environment around the home such as access to the property, for example steps leading up to the home.

f) Maintaining a habitable home environment - local authorities should consider whether the condition of the adult's home is sufficiently clean and maintained to be safe. A habitable home is safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas.

g) Developing and maintaining family or other personal relationships - local authorities should consider whether the adult is lonely or isolated, either because their needs prevent them from maintaining the personal relationships they have or because their needs prevent them from developing new relationships.

h) Accessing and engaging in work, training, education or volunteering - local authorities should consider whether the adult has an opportunity to apply themselves and contribute to society through work, training, education or volunteering, subject to their own wishes in this regard. This includes the physical access to any facility and support with the participation in the relevant activity.

i) Making use of necessary facilities or services in the local community including public transport and recreational facilities or services - local authorities should consider the adult's ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments.

j) Carrying out any caring responsibilities the adult has for a child - local authorities should consider any parenting or other caring responsibilities the person has. The adult may for example be a step-parent with caring responsibilities for their spouse's children.

As a consequence there is, or there is likely to be, a significant impact on the adult's wellbeing

6.107 The third condition that must be met is that local authorities must consider whether the adult's needs and their inability to achieve the outcomes above cause or risk causing a significant impact on their wellbeing. The meaning of wellbeing is set out in Section 1 of the Care Act and more detail is described in chapter 1 of this guidance.

6.108 Local authorities must determine how the adult's inability to achieve the outcomes above impacts on their wellbeing. Where the adult is unable to achieve more than one of the outcomes, the local authority does not need to consider the impact of each individually, but should consider whether the cumulative effect of being unable to achieve those outcomes is one of a 'significant impact on wellbeing'. In doing so, local authorities should also consider whether:

the adult's inability to achieve the outcomes above impacts on at least one of the areas of wellbeing (as described in Section 1 of the Act and chapter 1 of this guidance) in a significant way

the effect of the impact on a number of the areas of wellbeing mean that there is a significant impact on the adult's overall wellbeing

6.109 The term 'significant' is not defined by the regulations, and must therefore be understood to have its everyday meaning. Local authorities will have to consider whether the adult's needs and their consequent inability to achieve the relevant outcomes will have an important, consequential effect on their daily lives, their independence and their wellbeing.

6.110 In making this judgment, local authorities should look to understand the adult's needs in the context of what is important to him or her. Needs may affect different people differently, because what is important to the individual's wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.

6.111 The table below illustrates the interplay of the 3 conditions above, the outcomes listed in the eligibility regulations and the wellbeing principle, which is broken down into areas of wellbeing in (see chapter 1: Promoting wellbeing).

Eligibility decision process

1. Needs

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

2. Outcomes

As a result of the needs, the adult is unable to achieve 2 or more of the following:

3. Wellbeing

As a consequence, there is or is likely to be a significant impact on the adult's wellbeing, including the following:

6.112 The case studies which follow demonstrate examples of how eligibility determinations may be made. The purpose of these case studies is to illustrate eligibility on the basis of significant impact on wellbeing where the person has needs caused by a physical or mental impairment or illness which mean they are unable to achieve 2 or more outcomes specified in the Eligibility Regulations. Significant impact on wellbeing is personal, so although 2 people are in similar circumstances, the impact on their wellbeing is different.

Case Study 1: John (eligible)

John is 32 and has been referred by his mother for an assessment, who is concerned for John and his future. John is unemployed and lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far. John is able to manage his own personal care, but his mother does all the housework for both of them. John feels increasingly isolated and will not leave the house without his mother. It is important to John that he is intellectually stimulated and there is a chess club nearby which he would like to join, but John does not feel confident about this due to his anxiety in social situations.

Needs

Adult on the autistic spectrum.

Outcomes

John has severe difficulties socialising and co-operating with other people.

He only has transactional exchanges and cannot maintain eye contact. John knows that others feel uneasy around him, and spends a lot of his time alone. As a result, John is unable to achieve the following outcomes: Developing and maintaining family or other personal relationships and making use of necessary facilities and services in the community.

Impact on wellbeing

John is too anxious to initiate developing friendships on his own although he would like to and he feels lonely and depressed most of the time. His nervousness also affects his ability to take advantage of facilities in the community, which could help him feel less lonely. Feeling anxious and lonely has a significant impact on his wellbeing

Decision: Eligible

Next Actions

John's local authority thinks John's needs are eligible. Both John and the local authority agree that the most effective way of meeting John's needs is to develop his confidence to join the chess club. John uses his personal budget to pay for a support worker to accompany him to an autism social skills group, and to the chess club and to travel with him on the bus to get there.

John's local authority notes that John's mother could need support too and offers her a carer's assessment.

Case study 2: Dave (not eligible)

Dave is 32 and has been referred by his mother for an assessment, who is concerned for Dave and his future. Dave lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far.

Dave is able to manage his own personal care, but his mother does all the housework for both of them. Dave also works, but would like to get a job that is a better match for his intellectual abilities as his current job does not make the most of his numerical skills. Dave's social contact is mainly online because he feels more comfortable communicating this way and he spends a lot of time in his room on his computer.

Category

Adult on the autistic spectrum.

Needs

Dave struggles severely in social situations leading to difficulties accessing work and cooperating with other people. He only has transactional exchanges with others and cannot maintain eye contact. Dave knows that others feel uneasy around him and spends a lot of his time alone.

Impact on wellbeing

Dave is not in ideal employment, but has access to and is engaged in work. This has some impact on his wellbeing but not to a significant extent.

Dave prefers to socialise with people online. It emerges from conversations with Dave that he has access to those personal relationships that he considers essential. Dave is contributing to society, has contact with others, is in employment and is able to look after himself.

Decision: Not Eligible

Dave has difficulties doing some of the things that many other people would think should be a natural part of daily living and he is unable to participate in recreational activities in a conventional sense. Those aspects of his wellbeing that are affected by the needs caused by his autism are not so significantly affected that Dave's overall wellbeing is at risk.

The local authority decides that Dave's needs are not eligible, because they do not have a significant effect on his wellbeing despite his mother's concerns.

Next Actions

The local authority records Dave's assessment and sends him a copy. They include information about a local autism support group. Dave's local authority notes that Dave's mother could well need support and offers her a carer's assessment.

Fluctuating needs

6.113 Individuals with fluctuating needs may have needs which are not apparent at the time of the assessment, but may have arisen in the past and are likely to arise again in the future. Therefore local authorities must consider an individual's need over an appropriate period of time to ensure that all of their needs have been accounted for when eligibility is being determined. Where fluctuating needs are apparent, this should also be factored into the care plan, detailing the steps local authorities will take to meet needs in circumstances where these fluctuate. For example, an adult with a mental illness, which has been managed in the past 8 months but which could deteriorate, if circumstances in the adult's life change. In such situations, local authorities must consider the nature of the adult's needs have been over the past year to get a complete picture of the adult's level of need.

6.114 When considering the type of needs an adult may have, local authorities should note that there is no hierarchy of needs or of the areas of wellbeing as described in chapter 1 of this guidance.

Considering needs met by carers in eligibility determinations

6.115 The eligibility determination must be made based on the adult's needs and how these impact on their wellbeing. Authorities must only take consideration of whether the adult has a carer, or what needs may be met by a carer after the eligibility determination when a care and support plan is prepared. The determination must be based solely on the adult's needs and if an adult does have a carer, the care they are providing will be taken into account when considering whether the needs must be met. Local authorities are not required to meet any eligible needs which are being met by a carer, but those needs should be recognised and recorded as eligible during the assessment process. This is to ensure that should there be a breakdown in the caring relationship, the needs are already identified as eligible, and therefore local authorities must take steps to meet them without further assessment.

What is the national eligibility threshold for carers?

6.116 Carers can be eligible for support in their own right. The national eligibility threshold for carers is also set out in the Care and Support (Eligibility Criteria) Regulations 2015. The threshold is based on the impact a carer's needs for support has on their wellbeing.

6.117 In considering whether a carer has eligible needs, local authorities must consider whether:

A carer's needs are only eligible where they meet all 3 of these conditions.

Interpreting the carers' eligibility criteria

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

6.118 Local authorities must consider whether the carer's need for support arises because they are providing care to an adult. Carers can be eligible for support whether or not the adult for whom they care has eligible needs. The eligibility determination must be made based on the carer's needs and how these impact on their wellbeing. The determination should be made without consideration of whether or not the adult the carer cares for, has eligible needs.

6.119 The carer must also be providing necessary care. If the carer is providing care and support for needs which the adult is capable of meeting themselves, the carer may not be providing necessary support. In such cases, local authorities should provide information and advice to the adult and carer about how the adult can use their own strengths or services available in the community to meet their needs.

The effect of the carer's needs is that any of the circumstances specified in the Eligibility Regulations apply to the carer

6.120 The second condition that authorities must consider is whether the carer's physical or mental health is either deteriorating or is at risk of doing so, or whether the carer is unable to achieve any of a list of other outcomes which may apply.

6.121 Authorities must be aware that the regulations provide that 'being unable' to achieve outcomes, includes circumstances where the carer:

6.122 The Eligibility Regulations set out a range of outcomes. Local authorities must consider whether the carer is able to achieve these outcomes or if due to the nature of their needs they are unable to achieve any of the outcomes. The carer will have eligible needs met if they are unable to achieve any of these outcomes and as a result there is, or there is likely to be, a significant impact on their wellbeing.

6.123 The following section of the guidance provides examples of how local authorities should consider the outcomes set out in the Eligibility Regulations when they determine whether a carer meets the eligibility criteria. To be eligible, a carer must be unable to achieve any of the following outcomes:

Criteria

Examples of how to interpret the criteria

(i) carrying out any caring responsibilities the carer has for a child

Local authorities should consider any parenting or other caring responsibilities the carer has for a child in addition to their caring role for the adult. For example, the carer might be a grandparent with caring responsibilities for their grandchildren while the grandchildren's parents are at work.

(ii) providing care to other persons for whom the carer provides care

Local authorities should consider any additional caring responsibilities the carer may have for other adults. For example, a carer may also have caring responsibilities for a parent in addition to caring for the adult with care and support needs.

(iii) maintaining a habitable home environment

Local authorities should consider whether the condition of the carer's home is safe and an appropriate environment to live in and whether it presents a significant risk to the carer's wellbeing. A habitable home should be safe and have essential amenities such as water, electricity and gas.

(iv) managing and maintaining nutrition

Local authorities should consider whether the carer has the time to do essential shopping and to prepare meals for themselves and their family.

(v) developing and maintaining family or other significant personal relationships

Local authorities should consider whether the carer is in a position where their caring role prevents them from maintaining key relationships with family and friends or from developing new relationships where the carer does not already have other personal relationships.

(vi) engaging in work, training, education or volunteering

Local authorities should consider whether the carer can continue in their job, and contribute to society, apply themselves in education, volunteer to support civil society or have the opportunity to get a job, if they are not in employment.

(vii) making use of necessary facilities or services in the local community

Local authorities should consider whether the carer has an opportunity to make use of the local community's services and facilities and for example consider whether the carer has time to use recreational facilities such as gyms or swimming pools.

(viii) engaging in recreational activities

Local authorities should consider whether the carer has leisure time, which might for example be some free time to read or engage in a hobby.

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

6.124 The third condition that must be met is that local authorities must consider whether the carer's needs and their inability to achieve the outcomes above present a significant impact on the carer's wellbeing. 'Wellbeing' is defined by referring to examples of specific areas in Section 1 of the Care Act (see chapter 1). In doing so, local authorities should consider whether:

the carer's needs and inability to achieve the outcomes impact on an area of the carer's wellbeing in a significant way

the impact on a number of the areas of wellbeing is such that they have a significant impact on an adult's overall wellbeing

6.125 The term 'significant' is not defined by the Regulations, and must therefore be understood to have its everyday meaning. Local authorities will have to consider whether the carer's needs and their inability to achieve the outcomes will have an important, consequential effect on their daily lives, their independence and their own wellbeing.

6.126 In making this judgment, local authorities should look to understand the carer's needs in the context of what is important to them. The impact of needs may affect different carers differently, because what is important to the individual's wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.

6.127 When considering the type of needs a carer may have, local authorities should note that there is no hierarchy of needs or of the areas of wellbeing as described in chapter 1 of the guidance.

6.128 The following illustrates the interplay of the outcomes listed in the eligibility regulations and the wellbeing principle, which is broken down into areas of wellbeing in Chapter 1 of this guidance.

Carers' eligibility decision process

1. Needs

The needs arise as a consequence of providing necessary care to an adult, and the carer is 'unable' to achieve the following:

2. Outcomes

As a result of the carer's needs, either:

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

managing and maintaining nutrition

developing and maintaining family or other significant personal relationships

accessing and 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

3. Wellbeing

As a consequence, there is or is likely to be a significant impact on the carer's wellbeing, including:

6.129 The case studies which follow demonstrate examples of how eligibility determinations may be made. The purpose of these case studies is to illustrate eligibility on the basis of significant impact on wellbeing where the carer has needs caused by providing necessary care. Significant impact on wellbeing is personal, so although 2 people are in similar circumstances, the impact on their wellbeing is different.

Case Study 1: Deirdre (not eligible)

Deirdre is 58 and has been caring for her neighbour for the past 6 years. Deirdre has been coping with her caring responsibilities, which include checking in on her neighbour, doing her shopping and cleaning and helping her with the cooking every other day.

Deirdre works 20 hours a week at the local school, and she is also helping her daughter by picking up her grandchild after school. Deirdre's son is concerned that she is taking on too much and notices that she is tired. Deirdre's son persuades her to ask the local authority for a carer's assessment.

Caring responsibilities

Neighbour with COPD.

Outcomes

Deirdre enjoys the variety that her working life and caring role provide. She would like to be able to spend more time with her grandchild in the afternoons, but recognises that there is a balance between doing this and caring for her neighbour. Deirdre's needs impact on the following outcomes:

carrying out caring responsibilities the carer has for a child

engaging in recreational activities

Impact on wellbeing

Deirdre's needs are impacting on a few outcomes.

Deirdre enjoys her caring responsibility for her grandchild and would like more free time. On the other hand, her caring roles are fulfilling so although Deirdre is tired at the end of the day, her local authority does not think her wellbeing is significantly affected.

Decision: Not Eligible

The local authority decides that Deirdre is not eligible because her wellbeing is not significantly affected.

Next actions

The local authority recognises that Deirdre could do with some advice to help her manage her day so that she can find some time for herself and so she does not get tired. They advise on how she may reduce some of her tasks such as sitting down with her neighbour to order their food shopping online rather than carrying them home. They make contact with a local carers' organisation and the local authority makes sure Deirdre is able to access it. The organisation is able to provide additional advice.

Case study 2: Sam (eligible)

Sam is 38 and cares for his mother who has early-stage dementia. Sam's mother has telecare, but he still checks in on her daily, and does her shopping, cooking and laundry. Sam is a divorced father of 2 children, who live with him every other week. Sam works fulltime in an IT company and has come forward for an assessment as he is starting to feel unable to cope with his various responsibilities in the weeks when he looks after his children. Sam has made an arrangement with his employer that he can work longer hours on the weeks when the children are with their mother and fewer when he has the children.

Caring responsibilitie

Mother with early stage dementia.

Outcomes

Sam wants to spend more time with his children and for instance be able to free up an hour in the afternoon to help them with their homework, so it doesn't have to be done in the evening when the children are tired. Sam's needs impact on the following outcomes:

carrying out caring responsibilities the carer has for a child

engaging in recreational activities

Impact on wellbeing

Sam's responsibilities impact on a few important outcomes. Sam is starting to feel like he is failing as a parent and it affects the relationship he has with his children, his ex-wife, and his mother. He also worries that his ability to stay in work would be in jeopardy unless he receives support. Sam seems quite stressed and anxious.

Decision: Eligible

The local authority decides that Sam's fluctuating needs are eligible for support, because it perceives that they have a significant impact on his wellbeing. If the local authority supports Sam to maintain his current role, everyone is better off, because Sam can stay in employment, sustain his family relationships and provide security for his mother.

Next actions

The local authority gives Sam a direct payment which he uses to pay for a care worker to come in for 3 days every other week to check on his mother and make her a meal. This gives Sam more time to spend with his children, doing homework with them and spending some more relaxed time with them.

The local authority directs Sam to a carers' organisation which provides Sam with information about his rights at work and how to speak to his employers.

Fluctuating needs

6.130 Carers with fluctuating needs may have needs which are not apparent at the time of the assessment, but may have arisen in the past and are likely to arise again in the future. Therefore local authorities must consider an individual's need over an appropriate period of time to ensure that all of their needs have been accounted for when the eligibility is being determined. Where fluctuating needs are apparent, this should also be factored into the care plan, detailing the steps local authorities will take to meet needs in circumstances where these fluctuate. For example, a carer could be caring for an adult with a mental illness, who has managed their condition well in the past 8 months, but who could deteriorate, if circumstances in the adult's life change. In such situations, local authorities must consider how the carer's needs change as a result of the fluctuation in the needs of the person they are caring for. Authorities must get a complete picture of the carer's level of need over an appropriate period.

6.132 The level of a carer's need can also fluctuate irrespective of whether the needs of the adult for whom they care, fluctuate. For example, if the carer is a parent of school children, they may not have the same level of need for support during term time as during school holidays.

What must local authorities do after the eligibility determination?

6.132 When the eligibility determination has been made, local authorities must provide the person to whom the determination relates (whether that is an adult with care and support needs, or a carer with support needs) with a copy of their decision.

6.133 Where the person is found to have no eligible needs, local authorities must provide information and advice on what can be done to meet or reduce the needs (for example what support might be available in the community to help the adult or carer) and what can be done to prevent or delay the development of needs in the future. Local authorities should consider how this package of information can be tailored to the needs which the person does have, with the aim of delaying deterioration and preventing future needs, and reflect the availability of local support (see also chapter 2 on preventative services and chapter 3 on information and advice).

6.134 If the adult has some eligible needs, the local authority must:

7. Independent advocacy

This chapter provides guidance on:

Sections 67 and 68 of the Care Act 2014

the Care and Support (Independent Advocacy) Regulations 2014

This chapter covers:

7.1 The purpose of this section of guidance is to ensure that local authorities fully understand their duties in relation to the provision of independent advocacy and to assist them in carrying out these duties effectively.

7.2 There are duties to arrange an independent advocate for all adults, as part of their own assessment and care planning and care reviews and to those in their role as carers. It also applies to children who are approaching the transition to adult care and support, when a child's needs assessment is carried out, and when a young carer's assessment is undertaken.

7.3 There is also a separate duty to arrange an independent advocate for adults who are subject to a safeguarding enquiry or Safeguarding Adults Review ( SAR).

7.4 Local authorities must arrange an independent advocate to facilitate the involvement of a person in their assessment, in the preparation of their care and support plan and in the review of their care plan, as well as in safeguarding enquiries and SARs if 2 conditions are met. That if an independent advocate were not provided then the person would have substantial difficulty in being fully involved in these processes and second, there is no appropriate individual available to support and represent the person's wishes who is not paid or professionally engaged in providing care or treatment to the person or their carer. 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 for the safeguarding enquiry or SAR.

7.5 Everyone should have access to information and advice on care and support and keeping safe from abuse or neglect (see chapters 3 and 14). Prior to making contact with the local authority, there may be some people who require independent advocacy to access that information and advice. Local authorities will need to consider such needs in ensuring that the information and advice service is accessible. Subsequently, once a person has contacted the local authority, or come to the local authority's attention as a result of a safeguarding concern, they must be actively involved in identifying their needs through assessment, in developing their care and support plan, and in leading their care reviews, where relevant, and being involved in any safeguarding enquiry or SAR. The aim of the duty to provide advocacy is to enable people who have substantial difficulty in being involved in these processes to be supported in that involvement as fully as possible, and where necessary to be represented by an advocate who speaks on their behalf. The Equality Act 2010, requires that reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Provision of such adjustments, information in different formats for example, may reduce or remove a substantial difficulty a person may have in being involved. The ultimate aim is for people's wishes, feelings and needs to be at the heart of the assessment, care planning and review processes. This needs to be just as true for those who are the subject of a safeguarding enquiry or safeguarding adult review ( SAR).

Advocacy and the duty to involve

7.6 Local authorities must involve people in decisions made about them and their care and support or where there is to be a safeguarding enquiry or SAR. Involvement requires the local authority helping people to understand how they can be involved, how they can contribute and take part and sometimes lead or direct the process. People should be active partners in the key care and support processes of assessment, care and support and support planning, review and any enquiries in relation to abuse or neglect. No matter how complex a person's needs, local authorities are required to involve people, to help them express their wishes and feelings, to support them to weigh up options, and to make their own decisions.

7.7 The duty to involve applies in all settings, including for those people living in the community, in care homes or, apart from safeguarding enquiries and SARs, [footnote 24] in prisons, for example.

7.8 Local authorities must form a judgment about whether a person has substantial difficulty in being involved with these processes. If it is thought that they do, and that there is no appropriate individual to support and represent them for the purpose of facilitating their involvement, then the local authority must arrange for an independent advocate to support and represent the person.

7.9 Many of the people who qualify for advocacy under the Care Act will also qualify for advocacy under the Mental Capacity Act 2005. The same advocate can provide support as an advocate under the Care Act and under the Mental Capacity Act. This is to enable the person to receive seamless advocacy and not to have to repeat their story to different advocates. Under whichever legislation the advocate providing support is acting, they should meet the appropriate requirements for an advocate under that legislation.

Judging 'substantial difficulty' in being involved

7.10 Local authorities must consider for each person, whether they would have substantial difficulty in engaging with the local authority care and support processes. The Care Act defines 4 areas in any one of which a substantial difficulty might be found, which are set out below. Understanding relevant information

7.11 The first area to consider is 'understanding relevant information'. Many people can be supported to understand relevant information, if it is presented appropriately and if time is taken to explain it. Some people, however, will not be able to understand relevant information, for example if they have mid-stage or advanced dementia.

Retaining information

7.12 The second area to consider is 'retaining information'. If a person is unable to retain information long enough to be able to weigh up options and make decisions, then they are likely to have substantial difficulty in engaging and being involved in the process.

Using or weighing the information as part of engaging

7.13 The third area is 'using or weighing the information as part of the process of being involved.' A person must be able to weigh up information, in order to participate fully and express preferences for or choose between options. For example, they need to be able to weigh up the advantages and disadvantages of moving into a care home or terminating an undermining relationship. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process.

Communicating their views, wishes and feelings

7.14 The fourth area involves 'communicating their views, wishes and feelings'. A person must be able to communicate their views, wishes and feelings whether by talking, writing, signing or any other means, to aid the decision process and to make priorities clear. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process.

7.15 For example, a person with mid-stage or advanced dementia, significant learning disabilities, a brain injury or mental ill health may be considered to have substantial difficulty in communicating their views, wishes and feelings. But equally a person with Asperger's may be considered, as may a frail older person who does not have any diagnosis but is confused as a result of an infection, or a person who is near the end of their life and appears disengaged from involvement and decision-making. Within this context, it is the person's ability to communicate their views, wishes and feelings which is fundamental to their involvement rather than the diagnosis or specific condition.

7.16 Both the Care Act and the Mental Capacity Act recognise the same areas of difficulty, and both require a person with these difficulties to be supported and represented, either by family or friends, or by an advocate in order to communicate their views, wishes and feelings.

Case Study

Stephen sustained a brain injury in a fall; he has completed 6 months in a specialist residential rehabilitation setting and the next step is an assessment of need for his continuing support.

Prior to this, the social worker telephones Stephen's treating clinician who confirms that because of his brain injury, Stephen lacks insight into the effects this has had on him and he also has difficulty processing lots of information quickly - this is a common symptom of brain injury.

Therefore the social worker decides on an initial short meeting to determine Stephen's needs and knows her first step will be to evaluate if Stephen has difficulty understanding and therefore being involved in the assessment process. If so, support could come from a carer, family member or friend or Mental Capacity Advocate, as she is aware lack of insight does not necessarily determine lack of capacity.

The social worker notes that Stephen is able to retain information about who she is and why she is meeting with him. He is articulate and can converse well about his plans for the future which includes detailed plans to meet up with friends and return to work again. However, a pre-assessment conversation with his mother, confirms that his friendship group has significantly diminished as his friends find it difficult to understand the differences in his behaviour since his fall and doubts whether he will be able to return to full-time employment. The social worker judges that because Stephen lacks insight into his personal relationships and future plans, he may well also have trouble estimating his true care and support needs. At this point the social worker decides that Stephen would have substantial difficulty in being fully involved in the rest of the assessment process and would therefore benefit from assistance.

Stephen is adamant that he wants to act and make decisions independently of his mother, though he is happy for her to inform the assessment process. The social worker decides that Stephen's mother would not be an appropriate person under the Care Act to support his involvement in the needs assessment. The social worker talks to Stephen about how an independent advocate could help him make sure his views, beliefs, wishes and aspirations are taken into account in the assessment, and with his agreement, arranges for an independent advocate with specialist brain injury training to support him. The independent advocate meets Stephen but also talks to his mother to get a true picture of Stephen's current needs and wishes and to ascertain the differences between how Stephen is now and prior to acquiring his brain injury. The social worker carries out the needs assessment with Stephen who is supported by his independent advocate, and with Stephen's approval, input from his mother.

When the duty to provide independent advocacy applies

Assessment of needs

7.17 From the point of first contact, request or referral (including self-referral) for an assessment, the local authority must involve the person (see chapter 6 on Assessment). They must initially consider the best way of involving the person in the assessment processes, which is appropriate and proportionate to the person's needs and circumstances. In some cases this may be relatively brief, in others it may consist of a series of interviews, in the person's own home or other care settings, over a period of time.

7.18 At the start of the assessment process, if it appears to the local authority that a person has care and support or support needs, and throughout any subsequent part of the process, the local authority must judge whether a person has substantial difficulty in involvement with the assessment, the care and support planning or review processes. The identification of a potential need for advocacy may arise through the process, from the person themselves, carers or family. Where an authority has outsourced or commissioned all or some of this process, the authority will maintain overall responsibility for this judgement.

7.19 Where the local authority considers that a person has substantial difficulty in engaging with the assessment process, then they must consider whether there is anyone appropriate who can support the person be fully involved. This might for example be a carer (who is not professionally engaged or remunerated), a family member or friend. If there is no one appropriate, then the local authority must arrange for an independent advocate. The advocate must support and represent the person in the assessment, in the care and support planning, and the review. This applies to the following:

7.20 As part of the assessment and the care and support plan, the local authority must have regard to the need to help protect people from abuse and neglect. They should assist the person to identify any risks and ways to manage them. They should also assist the person to decide how much risk they can manage. The local authority must also have regard to ensuring that any restriction on the person's rights or freedom is kept to the minimum necessary. Restrictions should be carefully considered and frequently reviewed. Any potential deprivation of liberty must be authorised, either by a Deprivation of Liberty Authorisation by the local authority or the Court of Protection under the Deprivation of Liberty Safeguards in the Mental Capacity Act.

7.21 Where it appears that a person may be eligible for NHS Continuing Healthcare ( NHS CHC), local authorities must notify the relevant NHS body. NHS CHC is a package of ongoing care that is arranged and funded solely by the NHS where the individual has complex ongoing healthcare needs of a type or quantity such that they are found to have a 'primary health need' as set out in the national framework for NHS Continuing Healthcare and NHS-funded nursing care. Where an individual is not eligible for NHS CHC, local authorities still have a duty to carry out an assessment of needs where a person has an appearance of needs and a duty to meet those eligible needs (see chapter 6 on assessment) and therefore have a consequential duty to consider the need for an independent advocate to support the person's involvement in that assessment. This guidance applies equally to those people whose needs are being jointly assessed by the NHS and the local authority or where a package of support is, planned, commissioned or funded by both a local authority and a Clinical Commissioning Group ( CCG), known as a joint package of care.

7.22 These processes and arrangements have historically been difficult for individuals, their carers, family or friends, to understand and be involved in. Local authorities (with CCGs) will therefore want to consider the benefits of providing access to independent advice or independent advocacy for those who do not have substantial difficulty and/or those who have an appropriate person to support their involvement. Effective joint commissioning arrangements would involve:

7.23 Under the Mental Health Act 1983 ( MHA) certain people, known as 'qualifying patients', are entitled to the help and support from an Independent Mental Health Advocate (IMHA). Section 117 of the MHA places a duty on the NHS and local authorities to provide aftercare and this will usually involve a joint assessment (often under the Care Programme Approach) including an assessment of the person's care and support needs, a care and support or support plan and subsequent review (which may reach a decision that a person is no longer in need of aftercare). Those people who do not retain a right to an IMHA, whose care and support needs are being assessed, planned or reviewed should be considered for an advocate under the Care Act, if they have substantial difficulty in being involved and if there is no appropriate person to support their involvement (see paragraph 7.32).

Safeguarding enquiries and safeguarding adult reviews (SARs)

7.24 The local authority must arrange, where necessary, for an independent advocate to support and represent an adult who is the subject of a safeguarding enquiry or a safeguarding adult review. Where an independent advocate has already been arranged under s67 Care Act or under MCA 2005 then, unless inappropriate, the same advocate should be used.

7.25 Effective safeguarding is about seeking to promote an adult's rights as well as about protecting their physical safety and taking action to prevent the occurrence or reoccurrence of abuse or neglect. It enables the adult to understand both the risk of abuse and actions that she or he can take, or ask others to take, to mitigate that risk.

7.26 There is increasing case law on adult safeguarding from the Court of Protection which advocates and practitioners should be aware.

7.27 If a safeguarding enquiry needs to start urgently then it can begin before an advocate is appointed but one must be appointed as soon as possible. All agencies need to know how the services of an advocate can be accessed and what their role is.

7.28 It is critical in this particularly sensitive area (whether an enquiry or a SAR) that the adult is supported in what may feel a daunting process which may lead to some very difficult decisions. An individual who is thought to have been abused or neglected may be so demoralised, frightened, embarrassed or upset that independent advocacy provided under section 68 to help them to be involved will be crucial.

Case Study Lynette

Lynette, who has learning disabilities, lives in a care home. A support worker contacted the local authority because another resident, Fred, has come into Lynette's room late at night shouting on several occasions and most recently was seen pushing her. A safeguarding enquiry is started and the local authority appoint an independent advocate to support Lynette as they are concerned that she cannot express herself easily. When interviewed by the social worker Lynette cannot describe what happened. The social worker and advocate agree that the advocate will help Lynette to communicate how she feels.

The advocate spends time with Lynette. She explains what is happening and communicates with Lynette about different people that she lives with, including using photos, finding out more about her feelings. Lynette appears to be generally happy around the house and when going out, but is very distressed when she sees Fred in person, or even when she sees a picture of him. The advocate makes clear to the Local Authority what Lynette has communicated.

The local authority finds that whilst there is no doubt that Fred did what was reported, he may have done so as a result of his own confusion and distress. They agree a proposal from the registered manager of the care home that alarms will be put on Fred's door and staffing numbers increased to prevent a recurrence. The local authority agrees to review the situation after some weeks during which time the advocate stays in contact with Lynette in order to understand the impact of this decision on Lynette. The advocate finds that Lynette remains distressed by Fred's presence. She is concerned that the measures in place are not sufficient and writes this in a report to the local authority detailing what Lynette has communicated about where she lives and about Fred. The local authority agrees to look at what further action may be needed which might include considering whether Lynette and Fred should continue to share accommodation.

The main aspect of wellbeing promoted is protection from abuse and neglect, but also personal dignity and emotional wellbeing. The local authority has also demonstrated its regard for Lynette's views, wishes, feelings and beliefs.

Continuity of care and ordinary residence

7.29 The local authority which is carrying out the assessment, planning or review of the plan is responsible for considering whether an advocate is required. In the case of a person who is receiving care and support from one local authority and decides to move and live in another authority, the responsibility will move with the care and support assessment (see chapter 20). For a person whose care and support is being provided out of area (in a type of accommodation set out in the section on ordinary residence (see chapter 19) it will be the authority in which the person is ordinarily resident. Understanding of local communities may be an important consideration, so the advocacy/advocate should wherever possible be from the area where the person is resident at the time of the assessment, planning or review.

Consequences for local authorities

The local authority should have local policies to clarify the appointing of advocates:

from advocacy services out of their area that they may not have a direct commissioning relationship with (as it currently is with Independent Mental Capacity Advocate (IMCA))

for people placed out of area temporarily

for people who move from one area to another following an assessment and care and support planning in which an advocate is involved (the same advocate should be involved wherever practicable)

Care and support reviews

7.30 The local authority must involve the person, their carer and any other individual that the person wants to be involved in any review of their care and support plan, and take all reasonable steps to agree any changes (see chapter 13).

7.31 Local authorities must consider whether an advocate is required to facilitate the person's involvement in the review of a care and support plan and, if appropriate, appoint an advocate. This applies regardless of whether an advocate was involved at an earlier stage. Examples of when an advocate may be appointed at this stage despite not previously being involved include:

Judgements made by the local authority

An appropriate individual to facilitate the person's involvement

7.32 Local authorities must consider whether there is an appropriate individual (or individuals) who can facilitate a person's involvement in the assessment, planning or review processes, and this includes 3 specific considerations.

7.33 First, it cannot be someone who is already providing the person with care or treatment in a professional capacity or on a paid basis (regardless of who employs or pays for them). That means it cannot be, for example, the person's GP, nurse, key worker or care and support worker.

Case study: Janice

Janice is 43 and cares for her mother Sheena who is 72 who has advanced Parkinson's and increasing cognitive and communication difficulties. Janice cares for her mother in excess of 40 hours per week. Janice gave up work to care for her mother 5 years ago, and using her direct payment Sheena pays her daughter for 8 hours per week for care and support, including helping her with personal care, cooking meals and grocery shopping. Sheena preferred this to paying someone else - she prefers not to have strangers in the house and finds that others often do not understand her needs. As Janice is caring for her mother for many more hours than this, Janice has received a carers assessment and receives her own carers personal budget which she uses for breaks such as her weekly aerobics class which she finds helps her keep in touch with her friends, stay healthy, and deal with stress.

There is no-one else available to act as an appropriate individual to support Sheena in decision making. Both Sheena and Janice would be happy for Janice to take on this role. However, as Janice received a payment, she would not be regarded as an appropriate individual, though the guidance states that good practice should ensure Janice's views are sought as Sheena has made clear that she wishes this to happen.

7.34 Second the person's wish not to be supported by that individual should be respected. Where a person does not wish to be supported by a relative, for example, perhaps because they wish to be moving towards independence from their family, then the local authority cannot consider the relative appropriate. The person's wish not to be supported by that individual should be respected and if the person has capacity, or is competent to consent, the person's wishes must be followed. If the person has been judged to lack the capacity to make a decision, then the local authority must be satisfied that it is in a person's best interests to be supported and represented by the individual.

Case study

If the person already has an advocate, whose role so far has been to support the person on matters not under the Care Act, who is able and willing to facilitate their involvement in the assessment, planning and review processes then they may be an appropriate individual to support the person's involvement and represent them. They would be acting as an appropriate person rather than an independent advocate under the Care Act. If, however, that advocate fulfils the requirements for an independent advocate under the Care Act then they can be appointed as such.

Additionally, if an advocate is required under the Mental Capacity Act, and the local authority is going to appoint the same person to be that advocate, then the instruction, appointment and qualification of the advocate must also meet the requirements of the Mental Capacity Act.

7.35 Third, the appropriate individual is expected to support and represent the person and to facilitate their involvement in the processes. It is unlikely that some people will be able to fulfil this role easily, for instance a family member who lives at a distance and who only has occasional contact with the person, a spouse who also finds it difficult to understand the local authority processes, a friend who expresses strong opinions of her own prior to finding out those of the individual concerned, or a housebound parent. It is not sufficient to know the person well or to love them deeply; the role of the appropriate individual is to support the person's active involvement with the local authority processes (see chapter 6).

Case study: Jacinta

Jacinta is 26 and lives with her mother and father. She has 2 siblings aged 28 and 23 who have left the family home. Jacinta would also like to move to living more independently. Jacinta has moderate learning disabilities and finds it hard to retain information. Jacinta's parents are very worried that she won't be able to cope living in her own home and are against her doing so. In these circumstances Jacinta's parents would not be 'an appropriate person' who could effectively represent and support her involvement.

Case study: Brian

Brian is 84 and has advancing dementia. He lives alone in the house he owns. Brian has very limited mobility, has frequent falls and has difficulty in remembering to take medication and to eat. He has periods when he is confused and weighing up the longer term advantages and disadvantages of this care and support options, but has been judged to retain 'capacity' Brian says he feels very lonely. Social services are already providing some domiciliary care for which Brian is charged. The local authority is reviewing Brian's care plan. Brian's daughter and son in law who have had little contact with Brian over the past few years and will inherit the house are adamant that he can cope at home and does not need to go into a care home. In these circumstances, in addition to a lack of recent contact, there could be a conflict of interests and Brian's relatives would not be 'an appropriate person'.

7.36 It will clearly not be suitable for a person to be regarded as an appropriate individual where they are implicated in any enquiry of abuse or neglect or have been judged by a SAR to have failed to prevent an abuse or neglect.

7.37 Sometimes the local authority will not know at the point of first contact or at an early stage of the assessment whether there is someone appropriate to assist the person in engaging. They may need to appoint an advocate, and find later that there is an appropriate person in the person's own network. The advocate can at that stage 'hand over' to the appropriate person. Alternatively, the local authority may agree with the individual, the appropriate person and the advocate that it would be beneficial for the advocate to continue their role, though this is not a specific requirement under the legislation. Equally, it is possible that the local authority will consider someone appropriate who may then turn out to have difficulties in supporting the person to engage and be involved in the process. The local authority must at that point arrange for an advocate.

7.38 There may also be some cases where the local authority considers that a person needs the support of both a family member and an advocate; perhaps because the family member can provide a lot of information but not enough support, or because while there is a close relationship, there may be a conflict of interest with the relative, for example in relation to inheritance of the home.

7.39 If the local authority decides that they are required to appoint an independent advocate as the person does not have friends or family who can facilitate their involvement, the local authority must still consult with those friends or family members when the person asks them to (see chapter 6 on assessment).

7.40 It is the local authority's decision as to whether a family member or friend can act as an appropriate person to facilitate the individual's involvement. It is the local authority's responsibility to communicate this decision to the individual's friends and family where this may have been in question and whenever appropriate. The overall aim should be for people who need advocacy to be identified and when relevant, receive consistent support as early as possible and throughout the assessment, the care and support planning and the review processes.

7.41 The local authority may be carrying out assessments of 2 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 2 people. For example, if they both wish to be supported to live together in their own home, then it may make sense for one advocate to support both. But where for example one wishes for the other to be moved away, there may be a conflict of interest and 2 advocates will be needed. If any of the people involved - the people being assessed or taking part in care and support or support planning or the advocate - consider that it would be better to have different advocates, then separate advocates should be provided.

The exceptions: provision of an advocate even where they have family or others who can facilitate the person's involvement.

7.42 In general, a person who has substantial difficulty in being involved in their assessment, plan and review, will only become eligible for an advocate where there is no one appropriate to support their involvement. The exceptions are:

where the exercising of the assessment or planning function might result in placement in NHS-funded provision in either a hospital for a period exceeding 4 weeks or in a care home for a period of 8 weeks or more and the local authority believes that it would be in the best interests of the individual to arrange an advocate

where there is a disagreement, relating to the individual, between the local authority and the appropriate person whose role it would be to facilitate the individual's involvement, and the local authority and the appropriate person agree that the involvement of an independent advocate would be beneficial to the individual

Who can act as an advocate?

7.43 Advocates must have:

A suitable level of appropriate experience

This may, for example, be in non-instructed advocacy or in working with those groups of people who may have substantial difficulty in engaging with assessments and care and support planning

Appropriate training

This may, for example, initially be training in advocacy (non-instructed and instructed) or dementia, or working with people with learning disabilities. Once appointed, all independent advocates should be expected to work towards the National Qualification in Independent Advocacy (level 3) within a year of being appointed, and to achieve it in a reasonable amount of time

Competency in the task

This will require the advocacy organisation assuring itself that the advocates who work for it are all competent and have regular training and assessment

Integrity and good character

This might be assessed through: interview and selection processes; seeking and scrutinising references prior to employment and on-going DBS checks [footnote 25]

The ability to work independently of the local authority or body carrying out assessments, planning or

reviews on the local authority's behalf

This would include the ability to make a judgement about what a person is communicating and what is in a person's best interests, as opposed to in a local authority's best interests, and to act accordingly to represent this

Arrangements for regular supervision

This will require that the person meets regularly and sufficiently frequently with a person with a good understanding of independent advocacy who is able to guide their practice and develop their competence

7.44 The third updated version on the Advocacy Quality Performance Mark ( QPM) was published on 3 April 2014 by the National Development Team for Inclusion (NDTi). The QPM is a tool for providers of independent advocacy to show their commitment and ability to provide high quality advocacy services - essential for people to have their voices heard, to exercise choice and control and to live independently.

7.45 To prevent potential conflict of interest, the independent advocate must not be working for the local authority, or for an organisation that is commissioned to carry out assessments, care and support plans or reviews for the local authority unless the potential conflict of interests is adequately addressed within the organisation's structure (for example a different group within a company or through an effective 'firewall', as in the banking industry). In certain circumstances, in addition to their role under the Care Act, an advocate may assist an individual to develop their own care or support plan if requested to by the individual, but they cannot be the person to authorise the support plan or to approve care and support plans or reviews on behalf of the authority. Nor can an advocate be appointed if they are providing care or treatment to the individual in a professional or a paid capacity.

The role of the independent advocate

7.46 It is intended that advocates will decide the best way of supporting and representing the person they are advocating for, always with regard to the wellbeing and interest (including their views, beliefs and wishes) of the person concerned. This may involve creative approaches, for example, supporting someone to show film to help explain their needs, wishes or preferences.

Case study: Kate

Kate has profound and multiple learning disabilities. She doesn't use formal communication such as words or signs. She communicates using body language and facial expressions. In her assessment, Kate's independent advocate supports her to show some film of her visiting a local market, enjoying the colours and sounds around her. In this way, Kate is able to show the assessor some of the things that are important to her.

7.47 In addition, where practicable, they are expected to meet the person in private. Where a person has capacity, the advocate should ask and obtain their written consent to look at their records and to talk to their carer, family, friends, care or support worker and others who can provide information about their needs and wishes, their beliefs and values. Where a person does not have capacity to decide whether an advocate should look at their relevant records or talk to their family and friends, then the advocate should consult the records and the family and others as appropriate, but consulting the family and others only where the advocate considers this is in the person's best interests. The Care Act allows advocates to examine and take copies of relevant records in certain circumstances. This mirrors the powers of an Independent Mental Capacity Advocate.

7.48 Acting as an advocate for a person who has substantial difficulty in engaging with care and support or safeguarding processes is a responsible position. It includes:

assisting a person to understand the assessment, care and support planning and review and safeguarding processes. This requires advocates to understand local authority policies, and other agencies roles, and processes, the available assessment tools, the planning options, and the options available at the review of a care or support plan are required and good practice in safeguarding enquiries and SARs. It may involve advocates spending considerable time with the individual, considering their communications needs, their wishes and feelings and their life story, and using all this to assist the person to be involved and where possible to make decisions

assisting a person to communicate their views, wishes and feelings to the staff who are carrying out an assessment or developing a care or support plan or reviewing an existing plan or to communicate their views, wishes and feelings to the staff who are carrying out safeguarding enquiries or reviews

assisting a person to understand how their needs can be met by the local authority or otherwise - understanding for example how a care and support and support plan can be personalised, how it can be tailored to meet specific needs, how it can be creative, inclusive, and how it can be used to promote a person's rights to liberty and to family life

assisting the person to make decisions about their care and support arrangements - assisting them to weigh up various care and support options and to choose the ones that best meet the person's needs and wishes.

assisting the person to understand their rights under the Care Act - for an assessment which considers their wishes and feelings and which considers the views of other people; their right to have their eligible needs met, and to have a care or support plan that reflects their needs and their preferences, and in relation to safeguarding, understanding their right to have their concerns about abuse taken seriously and responded to appropriately. Also assisting the person to understand their wider rights, including their rights to liberty and family life. A person's rights are complemented by the local authority's duties, for example to involve the person, to meet needs in a way that is least restrictive of a person's rights

assisting a person to challenge a decision or process made by the local authority; and where a person cannot challenge the decision even with assistance, then to challenge it on their behalf

7.49 In terms of safeguarding there are some particular important issues for advocates to address. These include assisting a person to:

Representing

7.50 There will be times when an advocate will have concerns about how the local authority has acted or what decision has been made or what outcome is proposed. The advocate must write a report outlining their concerns for the local authority. The local authority should convene a meeting with the advocate to consider the concerns and provide a written response to the advocate following the meeting.

7.51 Where the individual does not have capacity, or is not otherwise able, to challenge a decision, the advocate must challenge any decision where they believe the decision is inconsistent with the local authority's duty to promote the individual's wellbeing.

7.52 Where a person has been assisted and supported and nevertheless remains unable to make their own representations or their own decisions, the independent advocate must use what information they have collected and found, and make the representations on behalf of the person. They must 'advocate' on their behalf, to put their case, to scrutinise the options, to question the plans if they do not appear to meet all eligible needs or do not meet them in a way that fits with the person's wishes and feelings, or are not the least restrictive of the person's life, and to challenge local authority decisions where necessary. The ultimate goal of this representation is to secure a person's rights, promote the individual's well-being and ensure that their wishes are taken fully into account.

The role of the local authority in supporting the advocate

7.53 The local authority is expected to recognise that an advocate's duty is to support and represent a person who has substantial difficulty in engaging with the local authority processes. The local authority must take into account any representations made by an advocate. The local authority must provide a written response to a report from an advocate which outlines concerns about how the local authority has acted or what decision has been made or what outcome is proposed. The local authority should understand that the advocate's role incorporates 'challenge' on behalf of the individual.

7.54 The local authority is responsible for ensuring that the relevant people who work for the authority are aware of the advocacy service and the authority's duty to provide such services (see chapter 3 on information and advice). It may engage with advocates to support this awareness raising.

7.55 The local authority should consider including the identification and referral of those people likely to benefit from independent advocacy (during assessment, care and support planning, review and safeguarding) through the care and support services they may commission. In doing so, the local authority should engage with domiciliary and residential care and support workers and agencies.

7.56 The local authority should take reasonable steps to assist the advocate in carrying out their role. For example, they should let other agencies know that an advocate is supporting a person, facilitating access to the person and to the records [footnote 26], they should propose a reasonable timetable for the assessment and the care and support plan (taking into consideration the needs of the person), and where the advocate wishes to consult family, friends or paid staff, the timetable should allow this. They should keep the advocate informed of any developments and of the outcome of the assessment and the care and support plan.

7.57 The local authority may make reasonable requests of the advocate for information or for meetings both in relation to particular individuals and in relation to the advocate's work more generally, and the independent advocate should comply with these.

7.58 The local authority must meet its duties in relation to working with an Independent Mental Capacity Advocate ( IMCA) provided under the Mental Capacity Act as well as those in relation to an advocate under the Care Act when the advocate is acting in both roles. These duties have been closely aligned so as to facilitate this.

Availability of advocacy services to people in the area

7.59 All local authorities must ensure that there is sufficient provision of independent advocacy to meet their obligations under the Care Act. There should be sufficient independent advocates available for all people who qualify, and it will be unlawful not to provide someone who qualifies with an advocate (see also chapter 4).

7.60 Advocacy should be seamless for people who qualify, so that they can benefit from the support of one advocate for their whole experience of care or safeguarding work. It rarely makes sense to have one advocate for assessment and another for care and support planning; the 2 are interrelated, and people who have substantial difficulty in engaging should not be expected to have to tell their story repeatedly to different advocates.

7.61 The Local Government and Public Involvement in Health Act 2007 (as amended by the Health and Social Care Act 2012), provides that local authorities are under a duty to work with their local CCGs, and other partners through the Health and Wellbeing Board to undertake Joint Strategic Needs Assessments for their areas and to develop Joint Health and wellbeing Strategies. Statutory Guidance, published in March 2013 makes clear that the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategies must be published, and have specific regard to: 'what health and social care information the community needs, including how they access it and what support they may need to understand it'.

7.62 Local authorities should be aware of and build on the current availability of independent advocacy services in its local area.

7.63 Independent advocacy under the duty flowing from the Care Act is similar in many ways to independent advocacy under the Mental Capacity Act ( MCA). Regulations have been designed to enable independent advocates to be able to carry out both roles. For both:

the independent advocate's role is to support and represent people

the independent advocate's role is primarily to work with people who do not have anyone appropriate to support and represent them

the independent advocates require a similar skill set

regulations about the appointment and training of advocates are similar

local authorities are under a duty to consider representations made by both independent advocates

independent advocates will need to be well known and accessible

independent advocates may challenge local authority decisions

people who qualify for an Independent Mental Capacity Advocate (an IMCA) in relation to the care planning and care review - as that planning may result in an eligible change of accommodation decision - will (in nearly all cases) also qualify for independent advocacy under the Care Act. The provisions of the Care Act are however wider and apply to care planning irrespective of whether it may result in a change of accommodation decision. People for whom there is a power to instruct an IMCA in relation to care review will (in nearly all cases) also qualify for independent advocacy under the Care Act. The Care Act however creates a duty rather than a power in relation to advocacy and care reviews

7.64 However, the duty to provide independent advocacy under the Care Act is broader and provides support to:

people who have capacity but who have substantial difficulty in being involved in the care and support 'processes'

people in relation to their assessment and/or care and support planning regardless of whether a change of accommodation is being considered for the person

people in relation to the review of a care and/or support plan

people in relation to safeguarding processes (though IMCAs may be involved if the authority has exercised its discretionary power under the MCA and appointed an IMCA if protective measures are being proposed for a person who lacks capacity, at the time to make the relevant decisions or understand their consequences)

carers who have substantial difficulty in engaging - whether or not they have capacity

people for whom there is someone who is appropriate to consult for the purpose of best interests decisions under the Mental Capacity Act, but who is not able and/or willing to facilitate the person's involvement in the local authority process

adults who are subject to a safeguarding enquiry or SAR

7.65 Frequently a person will be entitled to an advocate under the Care Act and then, as the process continues it will be identified that there is a duty to provide an advocate ( IMCA) under the Mental Capacity Act. This will occur for example when during the process of assessment or care and support planning it is identified that a decision needs to be taken about the person's long-term accommodation. It would be unhelpful to the individual and to the local authority for a new advocate to be appointed at that stage. It would be better that the advocate who is appointed in the first instance is qualified to act under the Mental Capacity Act (as IMCAs) and the Care Act and that the commissioning arrangements enable this to occur.

7.66 Local authorities do not have to commission one organisation to provide all types of statutory and non-statutory advocacy. But there may be advantages of working with one organisation or working through one liaison point for a consortium of advocacy providers:

Charging and financial assessment

This section includes chapters:

8. Charging and financial assessment

This chapter provides guidance on:

This chapter covers:

This chapter must be read in conjunction with Annexes A to F, which provide further technical and detailed information.

8.1 The Care Act provides a single legal framework for charging for care and support under sections 14 and 17. It enables a local authority to decide whether or not to charge a person when it is arranging to meet a person's care and support needs or a carer's support needs.

8.2 Where a local authority arranges care and support to meet a person's needs, it may charge the adult, except where the local authority is required to arrange care and support free of charge. The new framework is intended to make charging fairer and more clearly understood by everyone. The overarching principle is that people should only be required to pay what they can afford. People will be entitled to financial support based on a means-test and some will be entitled to free care. The framework is therefore based on the following principles that local authorities should take into account when making decisions on charging. The principles are that the approach to charging for care and support needs should:

8.3 Alongside this, local authorities should ensure there is sufficient information and advice available in a suitable format for the person's needs, in line with the Equality Act 2010 (in particular for those with a sensory impairment, with learning disabilities or for whom English is not their first language), to ensure that they or their representative are able to understand any contributions they are asked to make. Local authorities should also make the person or their representative aware of the availability of independent financial information and advice.

Common issues for charging

8.4 Local authorities have a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs. In all cases, a local authority has the discretion to choose whether or not to charge under section 14 of the Care Act following a person's needs assessment. Where it decides to charge, it must follow the Care and Support (Charging and Assessment of Resources) regulations and have regard to the guidance. The detail of how to charge is different depending on whether someone is receiving care in a care home, or their own home, or another setting. However, they share some common elements, which are set out in the following section.

8.5 The different approaches exist to reflect that the delivery model for care homes is relatively uniform across the country and it is therefore sensible to provide a single model for charging purposes. However, other models of care generally see a greater variety of approaches and innovation that we wish to continue.

8.6 Where a local authority chooses to charge, regulations determine the maximum amount a local authority can charge a person.

8.7 Only in care homes, where the financial assessment identifies that a person's resources exceed the capital limits, is a local authority precluded from paying towards the costs of care. Therefore, local authorities should develop and maintain a policy setting out how they will charge people in settings other than care homes. In deciding what it is reasonable to charge, local authorities must ensure that they do not charge more than is permitted under the regulations and as set out in this guidance.

8.8 The subsequent guidance and the supporting annexes assume that the appropriate assessment of needs has been carried out and the local authority has chosen to charge. It therefore provides detail on how to conduct the financial assessment for that person. The local authority has no power to assess couples or civil partners according to their joint resources. Each person must therefore be treated individually. (For further guidance on assessment of needs see Chapter 6.)

8.9 Where a person lacks capacity, they may still be assessed as being able to contribute towards the cost of their care. However, a local authority must put in place policies regarding how they communicate, how they carry out financial assessments and how they collect any debts that take into consideration the capacity of the person as well as any illness or condition. Local authorities are expected to use their social work skills both to communicate with people and also to design a system that works with, and for, very vulnerable people. Sometimes it is useful to consult with and engage with family members; however, family members may not have the legal right to access the person's bank accounts. Where possible, local authorities should work with someone who has the legal authority to make financial decisions on behalf of a person who lacks capacity. If there is no such person, then an approach to the Court of Protection is required.

8.10 The charging rules also apply equally to people in prison. Whilst prisoners have restricted access to paid employment and benefits (and earnings in prison are to be disregarded for the purposes of the financial assessments), any capital assets, savings and pensions will need specific consideration as set out in this chapter and relevant annexes. (For more information on prisons and approved premises see Chapter 17).

Capital limits

8.11 The financial limit, known as the 'upper capital limit', exists for the purposes of the financial assessment. This sets out at what point a person is entitled to access local authority support to meet their eligible needs. Full detail is set out in Annex B, and the local authority must read that guidance before undertaking a financial assessment.

8.12 The upper capital limit is currently set at £23,250. Below this level, a person can seek means-tested support from the local authority. This means that the local authority will undertake a financial assessment of the person's assets and will make a charge based on what the person can afford to pay. In the financial assessment capital below the lower capital limit - currently set at £14,250 - is not taken into account in the assessment of what a person can pay in tariff income assessed against their capital. Where a person's resources are below the lower capital limit of £14,250 they will not need to contribute to the cost of their care and support from their capital. However, for adults receiving care and support in locations other than in a care home the limits of £23,250 and £14,250 are simply minimums and local authorities have discretion to set their own higher capital limits if they wish, provided they are no lower than £23,250 for the upper limit and £14,250 for the lower limit.

8.13 A person with more in capital than the upper capital limit can ask their local authority to arrange their care and support for them. Where the person's needs are to be met by care in a care home, the local authority may choose to meet those needs and arrange the care, but is not required to do so. In other cases, the authority must meet the eligible needs if requested. However, these people are not entitled to receive any financial assistance from their local authority and in any case, may pay the full cost of their care and support until their capital falls below the upper capital limit.

8.14 The local authority must not charge for certain types of care and support which must be arranged free.

These are:

Carrying out a financial assessment

8.15 The legal framework for charging is set out in Sections 14 and 17 of the Care Act. When choosing to charge, a local authority must not charge more than the cost that it incurs in meeting the assessed needs of the person. It also cannot recover any administration fee relating to arranging that care and support. The only exception is in the case of a person with eligible needs and assets above the upper capital limit who has asked the local authority to arrange their care and support on their behalf. In such cases, the local authority may apply an administration fee to cover its costs. However, (see paragraphs 8.55 to 8.60 below) this must not be higher than the cost the local authority has incurred in arranging that care and support. This approach must also apply if the local authority has involved other organisations to deliver its duties in any way.

8.16 Where a local authority has decided to charge, except where a light touch assessment is permissible (see paragraph 8.22 below), it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. This could be provided alongside a person's care and support plan or separately, including via online means. It should explain how the assessment has been carried out, what the charge will be and how often it will be made, and if there is any fluctuation in charges, the reason. The local authority should ensure that this is provided in a manner that the person can easily understand, in line with its duties on providing information and advice.

8.17 In carrying out the assessment, the local authority must have regard to the detailed guidance set out in Annexes B and C that set out how both capital and income should be treated. A local authority must regularly reassess a person's ability to meet the cost of any charges to take account of any changes to their resources. This is likely to be on an annual basis, but may vary according to individual circumstances. However, this should take place if there is a change in circumstance or at the request of the person.

8.18 At the time of the assessment of care and support needs, the local authority must establish whether the person has the capacity to take part in the assessment. If the person lacks capacity, the local authority must find out if the person has any of the following as the appropriate person will need to be involved:

enduring power of attorney (EPA)

lasting power of attorney (LPA) for property and affairs

lasting power of attorney (LPA) for health and welfare

property and affairs deputyship under the Court of Protection

any other person dealing with that person's affairs (for example, someone who has been given appointeeship by the Department for Work and Pensions (DWP) for the purpose of benefits payments)

8.19 People who lack capacity to give consent to a financial assessment and who do not have any of the above people with authority to be involved in their affairs, may require the appointment of a property and affairs deputyship. Family members can apply for this to the Court of Protection or the local authority can apply if there is no family involved in the care of the person. While this takes some weeks, it then enables the person appointed to access information about bank accounts and financial affairs. A person with dementia for example should not be 'forced' to undertake a financial assessment, to sign documents they can no longer understand and should not be punished for any incomplete information that is elicited from them. The local authority should be working with an EPA, a LPA or a deputy instead.

8.20 In the financial assessment, the person's capital is taken into account unless it is subject to one of the disregards set out in Schedule 2 to the regulations and described in Annex B. The main examples of capital are property and savings. Where the person receiving care and support has capital at or below the upper capital limit (currently £23,250), but more than the lower capital limit (currently £14,250), they may be charged £1 per week for every £250 in capital between the 2 amounts. This is called 'tariff income'. For example, if a person has £4,000 above the lower capital limit, they are charged a tariff income of £16 per week.

8.21 In assessing what a person can afford to pay, a local authority must take into account their income. However, to help encourage people to remain in or take up employment, with the benefits this has for a person's well-being, earnings from current employment must be disregarded when working out how much they can pay. There are different approaches to how income is treated depending on whether a person is in a care home or receiving care and support in their own home. Full details are set out in Annex C on the treatment of income in care homes and other settings.

8.21a) As part of the Armed Forces Covenant, the government has committed to making sure veterans are not disadvantaged by their service and when appropriate receive special consideration. To support veterans injured on active service, payments to veterans under the War Pension Scheme, with the exception of Constant Attendance Allowance which is specifically intended to pay for care, must be disregarded in the assessment of what a veteran can pay for care from 10 April 2017. This brings payments to veterans under the War Pension Scheme into line with Guaranteed Income Payments under the Armed Forces Compensation Scheme which have been disregarded since October 2012.

'Light-touch' financial assessments

8.22 In some circumstances, a local authority may choose to treat a person as if a financial assessment had been carried out. In order to do so, the local authority must be satisfied on the basis of evidence provided by the person that they can afford, and will continue to be able to afford, any charges due. This is known as a 'light-touch' financial assessment.

8.23 The main circumstances in which a local authority may consider carrying out a light-touch financial assessment are:

1. a) Where a person has significant financial resources, and does not wish to undergo a full financial assessment for personal reasons, but wishes nonetheless to access local authority support in meeting their needs. In these situations the local authority may accept other evidence in lieu of carrying out the financial assessment and consider the person to have financial resources above the upper limit.

2. b) Where the local authority charges a small or nominal amount for a particular service (for example, for subsidised services) which a person is clearly able to meet and would clearly have the relevant minimum income left, and carrying out a financial assessment would be disproportionate.

3. c) When an individual is in receipt of benefits which demonstrate that they would not be able to contribute towards their care and support costs. This might include income from Jobseeker's Allowance.

8.24 Ways a local authority may be satisfied that a person is able to afford any charges due might include evidence that a person has either:

1. a) property clearly worth more than the upper capital limit, where they are the sole owner or it is clear what their share is

2. b) savings clearly worth more than the upper capital limit

3. c) sufficient income left following the charge due

8.25 Where the local authority is going to meet the person's needs, and it proposes to undertake a light-touch financial assessment, it should take steps to assure itself that the person concerned is willing, and will continue to be willing, to pay all charges due. It must also remember that it is responsible for ensuring that people are not charged more than it is reasonable for them to pay. Where a person does not agree to the charges that they have been assessed as being able to afford to pay under this route, a full financial assessment may be needed.

8.26 When deciding whether or not to undertake a light-touch financial assessment, a local authority should consider both the level of the charge it proposes to make, as well as the evidence or other certification the person is able to provide. They must also inform the person when a light-touch assessment has taken place and make clear that the person has the right to request a full financial assessment should they so wish, as well as making sure they have access to sufficient information and advice, including the option of independent financial information and advice.

Deprivation of assets and debts

8.27 People with care and support needs are free to spend their income and assets as they see fit, including making gifts to friends and family. This is important for promoting their wellbeing and enabling them to live fulfilling and independent lives. However, it is also important that people pay their fair contribution towards their care and support costs.

8.28 There are some cases where a person may have tried to deliberately avoid paying for care and support costs through depriving themselves of assets - either capital or income. Where a local authority believes they have evidence to support this, it must read Annex E concerning the deprivation of assets. In such cases, the local authority may either charge the person as if they still possessed the asset or, if the asset has been transferred to someone else, seek to recover the lost income from charges from that person. However, the local authority cannot recover more than the person gained from the transfer.

8.29 Where a person has accrued a debt, the local authority may use its powers under the Care Act to recover that debt. In deciding how to proceed, the local authority should consider the circumstances of the case before deciding a course of action. For example, a local authority should consider whether this was a deliberate avoidance of payment or due to circumstances beyond the person's control.

8.30 Ultimately, the local authority may institute County Court proceedings to recover the debt. However, they should only use this power after other reasonable alternatives for recovering the debt have been exhausted. Further details on how to pursue debts are set out in Annex D.

Charging for care and support in a care home

8.31 This section must be read in conjunction with Annex B on the treatment of capital and Annex C on the treatment of income in care homes.

8.32 Where a local authority has decided to charge and undertaken the financial assessment, it should support the person to identify options of how best to pay any charge. This may include offering the person a deferred payment agreement. In such cases, chapter 9 of the guidance must be considered.

8.33 Where a local authority is meeting needs by arranging a care home, it is responsible for contracting with the provider. It is also responsible for paying the full amount, including where a 'top-up' fee is being paid. However, where all parties are agreed it may choose to allow the person to pay the provider directly for the 'top-up' where this is permitted. In doing so it should remember that multiple contracts risk confusion and that the local authority may be unable to assure itself that it is meeting its responsibilities under the additional cost provisions in the Care Act. Local authorities must ensure they read the guidance at Annex A on the use of 'top-up' fees.

8.34 Where a person is a short-term or temporary resident there is a degree of discretion or modified charging rules to take account of this.

A short-term resident is someone provided with accommodation in a care home for a period not exceeding 8 weeks, for example where a person is placed in a care home to provide respite care. Where a person is a short-term resident a local authority may choose to assess and charge them based on the rules for care or support arranged other than in a care home.

A temporary resident is someone whose stay in a care home is unlikely to exceed 52 weeks or, in exceptional circumstances, is unlikely to substantially exceed 52 weeks. Because a temporary resident is expected to return home their main or only home is usually disregarded in the assessment of whether and what they can afford to pay. In addition, for example, certain housing-related costs are also disregarded in the financial assessment.

8.35 People in a care home will contribute most of their income, excluding their earnings, towards the cost of their care and support. However, a local authority must leave the person with a specified amount of their own income so that the person has money to spend on personal items such as clothes and other items that are not part of their care. This is known as the personal expenses allowance ( PEA). This is in addition to any income the person receives from earnings. Ministers have the power to adjust the PEA. Any changes are communicated by Local Authority Circular and are binding. Local authorities have discretion to apply a higher income allowance in individual cases, for example where the person needs to contribute towards the cost of maintaining their former home. Further detail is set out in Annex C.

Choice of accommodation

8.36 Where the care planning process has determined that a person's needs are best met in a care home, the local authority must provide for the person's preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings. Determining the appropriate type of accommodation should be made with the adult as part of the care and support planning process, therefore this choice only applies between providers of the same type.

8.37 The local authority must ensure that the person has a genuine choice of accommodation. It must ensure that at least one accommodation option is available and affordable within the person's personal budget and it should ensure that there is more than one of those options. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party or in certain circumstances the resident is willing and able to pay the additional cost ('top-up'). However, an additional payment must always be optional and never as a result of commissioning failures leading to a lack of choice. Detailed guidance is set out in Annex A which a local authority must have regard to.

Charging for care and support in other care settings including a person's own home

8.38 This section should be read in conjunction with the regulations and Annex B on the treatment of capital and Annex C on the treatment of income in non-residential care.

8.39 These charging arrangements cover any setting for meeting care and support needs outside of a care home. For example, care and support received in a person's own home, and in other accommodation settings such as in extra care housing, supported living accommodation or shared lives arrangements.

8.40 The intent of the regulations and guidance is to support local authorities to assess what a person can afford to contribute towards their care costs. Local authorities should also consider how to use their discretion to support the principles of care and support charging.

8.41 This guidance does not make any presumption that local authorities will charge for care and support provided outside care homes, but enables them to continue to allow discretion.

8.42 Because a person who receives care and support outside a care home will need to pay their daily living costs such as rent, food and utilities, the charging rules must ensure they have enough money to meet these costs. After charging, a person must be left with the minimum income guarantee ( MIG), as set out in the Care and Support (Charging and Assessment of Resources) Regulation 2014. In addition, where a person receives benefits to meet their disability needs that do not meet the eligibility criteria for local authority care and support, the charging arrangements should ensure that they keep enough money to cover the cost of meeting these disability-related costs.

8.43 Additionally, the financial assessment of their capital must exclude the value of the property which they occupy as their main or only home. Beyond this, the rules on what capital must be disregarded are the same for all types of care and support. However, local authorities have flexibility within this framework; for example, they may choose to disregard additional sources of income, set maximum charges, or charge a person a percentage of their disposable income. This will help support local authorities to take account of local circumstances and promote integration and innovation.

8.44 Although local authorities have this discretion, this should not lead to 2 people with similar needs, and receiving similar types of care and support, being charged differently.

8.45 Local authorities should develop and maintain a policy on how they wish to apply this discretion locally. In designing this policy local authorities should consider the objectives of care and support charging and how it can:

8.46 Local authorities should consult people with care and support needs when deciding how to exercise this discretion. In doing this, local authorities should consider how to protect a person's income. The government considers that it is inconsistent with promoting independent living to assume, without further consideration, that all of a person's income above the minimum income guarantee ( MIG) is available to be taken in charges.

8.47 Local authorities should therefore consider whether it is appropriate to set a maximum percentage of disposable income (over and above the guaranteed minimum income) which may be taken into account in charges.

8.48 Local authorities should also consider whether it is appropriate to set a maximum charge, for example these might be set as a maximum percentage of care home charges in a local area. This could help ensure that people are encouraged to remain in in their own homes, promoting individual wellbeing and independence.

Charging for support to carers

8.49 Where a carer has eligible support needs of their own, the local authority has a duty, or in some cases a power, to arrange support to meet their needs. Where a local authority is meeting the needs of a carer by providing a service directly to a carer, for example a relaxation class or driving lessons, it has the power to charge the carer. However, a local authority must not charge a carer for care and support provided directly to the person they care for under any circumstances.

8.50 Local authorities are not required to charge a carer for support and indeed in many cases it would be a false economy to do so. When deciding whether to charge, and in determining what an appropriate charge is, a local authority should consider how it wishes to express the way it values carers within its local community as partners in care, and recognise the significant contribution carers make. Carers help to maintain the health and wellbeing of the person they care for, support this person's independence and enable them to stay in their own homes for longer. In many cases of course, carers voluntarily meet eligible needs that the local authority would otherwise be required to meet. Local authorities should consider carefully the likely impact of any charges on carers, particularly in terms of their willingness and ability to continue their caring responsibilities. It may be that there are circumstances where a nominal charge may be appropriate, for example to provide for a service which is subsidised but for which the carer may still pay a small charge, such as a gym class. Ultimately, a local authority should ensure that any charges do not negatively impact on a carer's ability to look after their own health and wellbeing and to care effectively and safely.

8.51 While charging carers may be appropriate in some circumstances, it is very unlikely to be efficient to systematically charge carers for meeting their eligible needs. This is because excessive charges are likely to lead to carers refusing support, which in turn will lead to carer breakdown and local authorities having to meet more eligible needs of people currently cared for voluntarily. As an example, work carried out by Surrey County Council found that if even 10% of people with care and support needs in families supported by carers presented to the council with eligible needs as a result of carer breakdown, the resulting cost would be 3 times the current total budget for carer support. The ADASS produced the Economic Case for Investment in Carers, a short factsheet for local authorities to use in considering whether to put in place a policy of charging carers, setting out the evidence that charging would be a false economy.

8.52 Local authorities may also wish to consider whether charging is proportionate when carers' assessments are undertaken for small scale help. There is a risk that financial assessments might become the most costly part of the process and something that is administratively burdensome.

8.53 Where a local authority takes the decision to charge a carer, it must do so in accordance with the non-residential charging rules. In doing so, it should usually carry out a financial assessment to ensure that any charges are affordable. However, it may be more likely, in the case of a carer, that the carer and the local authority will agree that a full financial assessment would be disproportionate as carers often face significantly lower charges.

8.54 In such cases, a local authority may choose to treat a carer as if a financial assessment has been carried out. When deciding whether or not to undertake a light-touch financial assessment, a local authority should consider both the level of the charge it proposes to make as well as the evidence the person is able to provide that they will be able to afford the charge. They must also inform the person when a light-touch assessment has taken place and make clear from the outset that the person has the right to request a full financial assessment should they so wish.

8.55 A carer's assessment may identify that the carer's needs for support could be met by arranging time away from the person they care for, for instance so that they can stay on top of other aspects of their lives, and that in order to achieve this services need to be provided to support the cared-for person in their absence. Such services would be provided direct to the cared-for person, even though they may meet the needs of both parties and may have been identified through the carer's assessment. The local authority may not charge the carer for these services, and any charges should be based on the local authority's policy on charging for non-residential care and support.

Requesting local authority support to meet eligible needs

8.56 People with eligible needs and financial assets above the upper capital limit may ask the local authority to meet their needs. This could be for a variety of reasons such as the person finding the system too difficult to navigate, or wishing to take advantage of the local authority's knowledge of the local market of care and support services. Where the person asks the local authority to meet their eligible needs, and it is anticipated that their needs will be met by a care home placement, then the local authority may choose to meet their needs, but is not required to do so. In other cases, where the needs are to be met by care and support of some other type, the local authority must meet those eligible needs.

8.57 Local authorities should therefore take steps to make people aware that they have the right to request the local authority to meet their needs, in certain circumstances even when they have resources above the financial limits and would not be entitled to financial support with any charges. They should also be clear that this right does not extend to needs met by a care home placement, although local authorities may choose to apply the same approach locally. Local authorities should also offer support to people in meeting their own needs, including providing information and advice on different options, and may offer to arrange contracts with providers.

8.58 Where the person's resources are above the financial limit, the person's entitlement to local authority support in meeting their needs may be dependent on the request having been made. Therefore it is important that the person, and any carer, advocate or other person they wish to involve, are aware of this ability and the consequences for their care and support. The local authority must make clear to the person that they may be liable to pay an arrangement fee in addition to the costs of meeting their needs to cover the costs of putting in place the care and support required.

8.59 Arrangement fees charged by local authorities must cover only the costs that the local authorities actually incur in arranging care. Arrangement fees should take account of the cost of negotiating and/or managing the contract with a provider and cover any administration costs incurred. Where a local authority chooses to meet the needs of a person with resources above the financial limit who requires a care home placement, it must not charge an arrangement fee. This is because it would support that person under its power (rather than its duty) to meet needs, and the ability to charge the arrangement fee applies only to circumstances when the authority is required to meet needs.

8.60 Local authorities must not charge people for a financial assessment, a needs assessment or the preparation of a care and support plan.

8.61 It may be appropriate for local authorities to charge a flat rate fee for arranging care. This can help ensure people have clarity about the costs they will face if they ask the local authority to arrange their care. However, such flat rate costs must be set at a level where they do not exceed the costs the local authority actually incurs.

8.62 The information provided to the person following a financial assessment should include information on the right to request the local authority to meet their needs - and how they would be charged - and the advice and support that is available to help people make arrangements to meet their own needs whatever type of support they require.

8.63 A local authority will be under a duty to meet a person's eligible needs when requested to do so and their needs are to be met by care and support other than in a care home. However, where the person has resources above the financial limits the local authority may charge the person for the full cost of their care and support. In such circumstances, the person remains responsible for paying for the cost of their care and support, but the local authority takes on the responsibility for meeting those needs. This means that the local authority may for example provide or arrange care and support, or make a direct payment which may be a paper based exercise, or some combination of these. Further information on how, to 'meet needs' and the options available is provided in chapter 10.

8.64 The local authority must assure itself that whilst the person remains responsible for paying for their own care, they have sufficient assets for the arrangements that it puts in place to remain both affordable and sustainable. The local authority should also take steps to avoid disputes and additional liabilities by securing a person's agreement in writing to pay the costs that they are responsible for in meeting their needs, including payments to providers. Local authorities should make similar arrangements with any third parties that agree to contribute towards these costs.

Pension reforms

8.65 Reforms to defined contribution pensions came into effect from April 2015. The aim of the reforms is to provide people with much greater flexibility in how they fund later life. The government expects there to be a range of new products that people will use to manage and access money from their pensions as and when they need it, and where possible, these should be treated similarly to existing drawdown products for charging purposes.

8.66 The Pension wise service helps people to make informed choices at the point of retirement. This will include information and advice on later life, including the risk that they may need care and support in the future, and will have to pay for it.

8.67 For the purposes of charging, a local authority must follow the guidance set out on the treatment of income and capital in Annexes B and C and treat a person's assets accordingly. Where a person has chosen to withdraw funds from their pension pot and manage it directly, for example combining it with other assets rather than through a pensions product, this may be treated as capital under the rules laid out in Annex B.

Complaints

8.68 A person may wish to make a complaint about any aspect of the financial assessment or how a local authority has chosen to charge. A local authority must make clear what its complaints procedure is and provide information and advice on how to lodge a complaint.

8.69 Complaints about the level of charge levied by a local authority are subject to the usual care and support complaints procedure as set out in The Local Authority Social Services and NHS Complaints (England) Regulations 2009.

8.70 Where a local authority has established a special panel or fast track review processes to deal with financial assessment/charging issues, they should remind the person that they still have access to the statutory complaints procedure.

9. Deferred payment agreements

This chapter provides guidance on:

sections 34-36 of the Care Act 2014

the Care and Support (Deferred Payment) Regulations 2014 (as amended by the Care and Support (Deferred Payment)(Amendment) Regulations 2017) [see note 1]

This chapter covers:

Note 1

The legislation that underpinned deferred payment agreements ( DPAs) did not work as intended. It meant that local authorities ( LAs) in England were not required to offer DPAs to eligible individuals unless they were meeting that individual's needs or believed they would meet their needs if asked. We therefore made amendments to the Care and Support (Deferred Payment) Regulations 2014 so that LAs are now required to enter into a 'loan-type' DPA with individuals who qualify for one but whose needs the LA is not meeting. This chapter was amended on 12 February 2018 to reflect these changes in the law and to provide greater clarity on the types of DPAs that can be offered (see paragraphs 9.3, 9.7 and 9.10 to 9.13).

Definitions

9.1 'Care costs' - all costs charged to a person by a care provider, including any top-ups and core care costs. This includes the costs associated with the provision of supported accommodation.

9.2 'Top ups' - this term has the usual meaning accorded to it within the care and support sector, but for the avoidance of doubt, top ups are costs due to a local authority under Section 30 of the Care Act or costs for the provision of the type of care referred to in Section 34(3)(a) of the Care Act.

Introduction

9.3 The establishment of the universal deferred payment scheme means that people should not be forced to sell their home in their lifetime to pay for their care. By entering into a deferred payment agreement, a local authority agrees to:

defer the payment of charges due to it from the adult, for the costs of meeting needs in a care home or supported living accommodation

or

defer the repayment of a loan to the adult in instalments, to cover the costs of care and support in a care home or supported living accommodation

Deferring payment can help people to delay the need to sell their home, and provides peace of mind during a time that can be challenging (or even a crisis point) for them and their loved ones as they make the transition into care.

9.4 A deferred payment agreement can provide additional flexibility for when and how someone pays for their care and support. It should be stressed from the outset that the payment for care and support is deferred and not 'written off'. The costs of provision of care and support will have to be repaid by the individual (or a third party on their behalf) at a later date.

9.5 The scheme is universally available throughout England, and local authorities are required to offer deferred payment agreements to people who meet certain criteria governing eligibility set out in paragraph 9.7 below (the qualifying criteria) for the scheme. Local authorities need to ensure that adequate security is in place for the amount being deferred, so that they can be confident that the amount deferred will be repaid in the future. Local authorities are also encouraged to offer the scheme more widely to anyone they feel would benefit who does not fully meet the criteria.

9.6 A deferral can last until death. However, many people choose to use a deferred payment agreement as a 'bridging loan' to give them time and flexibility to sell their home when they choose to do so. This is entirely up to the individual to decide. Further details on deferred payment agreements are set out in the sections below.

Who to offer deferred payment agreements to

Qualifying criteria for deferred payment agreements

9.7 Deferred payment agreements are designed to prevent people from being forced to sell their home in their lifetime to meet the cost of their care. Local authorities must offer them to people who meet the criteria below and who are able to provide adequate security (see section entitled 'Obtaining Security' below). Subject to these criteria they must offer them to people who have their needs met by the local authority, and also people who meet their own needs. The regulations provide that someone must be offered a deferred payment agreement if they meet all of the following criteria at the point of applying for a deferred payment agreement. Broadly, they are that the:

1. a) person is ordinarily resident in the local authority area or present in the area but of no settled residence; or ordinarily resident in another local authority area but the local authority has determined that they will or would meet the individual's care needs under section 19 of the Care Act if asked to do so [see note 2]

2. b) person has needs which are to be met by the provision of care in a care home. This is determined when someone is assessed as having care and support needs [see note 3] which the local authority considers should be met through a care home placement

3. c) person has less than (or equal to) £23,250 in assets excluding the value of their main or only home (for example, in savings, other non-housing assets and housing assets other than their main or only home)

4. d) person's home is not disregarded [see note 4]; for example, it is not occupied by a spouse or dependent relative as defined in regulations on charging for care and support (for example, someone whose home is taken into account in the local authority financial assessment and so might need to be sold)

Note 2

Where a local authority is meeting an individual's care and support needs under section 19(2) of the Care Act.

Note 3

When someone is arranging their own care and support and the authority has not performed an assessment, this condition is satisfied when someone would be assessed as having eligible needs were the authority to have carried out such an assessment.

Note 4

Disregarded for the purposes of the financial assessment carried out under section 17 of the Act.

9.8 As well as providing protection for people facing the prospect of having to sell their home to pay for care, deferred payment agreements can offer valuable flexibility, giving people greater choice over how they pay their care costs. Local authorities are, at their discretion, permitted to be more generous than these criteria and offer deferred payment agreements to people who do not meet criteria b, c or d in section 9.7. In deciding whether someone who does not meet all of the criteria above should still be offered a deferred payment, some considerations a local authority may wish to take into account include (but are not limited to):

1. a) whether meeting care costs would leave someone with very few accessible assets (this might include assets which cannot quickly or easily be liquidated or converted to cash)

2. b) if someone would like to use wealth tied up in their home to fund more than just their core care costs and purchase affordable top-ups (see further guidance on 'How much can be deferred', paragraph 9.36)

3. c) whether someone has any other accessible means to help them meet the cost of their care and support

4. d) if a person is narrowly not entitled to a deferred payment agreement given the criteria above, for example because they have slightly more than the £23,250 asset threshold. This should include people who are likely to meet the criteria in the near future

9.9 Local authorities may also at their discretion enter into deferred payment agreements with people whose care and support is provided in supported living accommodation. The local authority should not exercise this discretion unless the person intends to retain their former home and pay the associated care and accommodation rental costs from their deferred payment. Further details on precisely what qualifies as supported living accommodation are set out in regulations. Deferred payment agreements cannot be entered into to finance mortgage payments on supported living accommodation.

Types of deferred payment agreement

9.10 Deferred payment agreements can take 2 forms:

the local authority pays the care home or supported living accommodation directly and defers the charges due to it from the individual (traditional type)

the individual pays the care provider for their care and the local authority loans them the cost of care in instalments less any contributions the individual contributes from other sources (loan type)

9.11 When considering their approach as to when or whether to offer loan or traditional type deferred payment agreements, local authorities should have regard to their duties under the Care Act, including their duties under the well-being principle and their market duties. Local authorities cannot refuse to enter into a loan-type deferred payment agreement if the qualifying criteria are met and the individual requests it (subject to paragraphs 9.14 to 9.17 below).

9.12 The local authority must comply with all relevant legislation and act under the guidance.

9.13 In all cases, a local authority is only required to enter into a deferred payment agreement to cover the costs of care and support which it considers necessary.

Permission to refuse a deferred payment agreement

9.14 A local authority must offer a deferred payment to someone meeting the qualifying criteria for deferred payment agreements and who is able to provide adequate security for the debt (obtaining a first land registry charge on their property, see 'Obtaining security' at paragraph 9.58); and may offer a deferred payment agreement to others who do not meet the criteria, at their discretion.

9.15 There are, however, certain circumstances in which a local authority may refuse a request for a deferred payment agreement ('permission to refuse'), even if a person meets the qualifying criteria and the local authority would otherwise be required to offer the person an agreement. This permission (or discretion) to refuse is intended to provide local authorities with a reasonable safeguard against default or non-repayment of debt.

9.16 A local authority may refuse a deferred payment agreement despite someone meeting the qualifying criteria:

1. a) where a local authority is unable to secure a first charge on the person's property

2. b) where someone is seeking a top up [see note 5]

3. c) where a person does not agree to the terms and conditions of the agreement, for example a requirement to insure and maintain the property

Note 5

In these situations, a local authority should still seek to offer a deferred payment agreement but should be guided by principles in the section 'How much to defer', to determine a maximum amount that is sustainable (or reflects their core care costs without any top-ups) and agree a deferral. The person can then choose whether they wish to agree

9.17 In any of the above circumstances, a local authority should consider whether to exercise its discretion to offer a deferred payment anyway (for example, if a person's property is uninsurable but has a high land value, the local authority may choose to accept charges against this land as security instead).

Circumstances in which local authorities may stop deferring care costs or making payments under a loan-type agreement

9.18 There are also circumstances where a local authority may refuse to defer or loan any more charges for a person who has an active deferred payment agreement. Local authorities cannot demand repayment in these circumstances, and repayment is still subject to the usual terms of termination, as set out in the section entitled 'termination of the agreement' below.

9.19 The local authority should provide a minimum of 30 days' advance notice that further deferrals or loans will cease; and should provide the person with an indication of how their care costs will need to be met in future. Depending on their circumstances, the person may either receive local authority support in meeting the costs of their care, or may be required to meet their costs from their income and assets. Local authorities exercising these powers to cease deferring additional amounts should consider their decision to do so whilst considering the person's circumstances and their overarching duties under the well-being principle.

9.20 Circumstances in which a local authority may refuse to defer or loan any more charges include[footnote 25]:

1. a) when a person's total assets fall below the level of the means-test (see chapter 8), and the person becomes eligible for local authority support in paying for their care

2. b) where a person no longer has need for care in a care home (or where appropriate supported living accommodation)

3. c) if a person breaches certain predefined terms of their contract (which must be clearly set out in the contract) and the local authority's attempts to resolve the breach are unsuccessful and the contract has specified that the authority will stop making further payments in such a case

4. d) if, under the charging regulations (see also chapter 8), the property becomes disregarded for any reason and the person consequently qualifies for local authority support in paying for their care, including but not limited to:

1. (i) where a spouse or dependent relative (as defined in charging regulations) has moved into the property after the agreement has been made, where this means the person is eligible for local authority support in paying for care and no longer requires a deferred payment agreement

2. (ii) where a relative who was living in the property at the time of the agreement subsequently becomes a dependent relative (as defined in charging regulations). The local authority may cease further deferrals at this point

9.21 Local authorities should not exercise these discretionary powers if a person would, as a result, be unable to pay any tariff income due to the local authority from their non-housing assets.

9.22 Local authorities must also cease deferring or loaning further amounts when a person has reached the 'equity limit' that they are allowed to defer (see 'how much can be deferred' below); or when a person is no longer receiving care and support in either a care home setting or in supported living accommodation. This also applies when the value of the security has dropped and so the equity limit has been reached earlier than expected. [footnote 26]

Case study 1

Lucille develops a need for a care home placement. She lives alone and is the sole owner of her home. Her home is valued at £165,000, and she has £15,000 in savings. Lucille meets the qualifying criteria for a deferred payment.

Information and advice

9.23 Under the Care Act, local authorities have responsibilities to provide information and advice about people's care and support. These extend to deferred payment schemes as well. This chapter should be read in combination with chapter 3 ('Information and Advice').

9.24 In order to be able to make well-informed choices, it is essential that people access appropriate information and advice before taking out a deferred payment agreement ( DPA). It is also important that people are kept informed about their DPA throughout the course of the agreement, and that they (and the executor of their estate where appropriate) receive the necessary information upon termination of the agreement.

9.25 Information and advice requirements prior to taking out a DPA are discussed in this section; requirements on local authorities while the DPA is in place are discussed in a separate section below (see 'the local authority's responsibilities whilst the agreement is in place'); and the section entitled 'termination of the agreement' addresses the responsibilities on the local authority when the agreement is concluded. The requirements on local authorities to offer and facilitate access to financial information and advice on other options for paying for care are discussed in chapter 3.

9.26 Deferred payment agreements are often made during a time that is demanding for a person and their loved ones - a period when they are making a transition into a care home. People may need additional support during this period, and the local authority has a role in providing this support and facilitating their transition, particularly if their transition to care is made rapidly and/or at an unexpected point. The local authority must provide information in a way which is clear and easy to understand, and it should be designed to ease the process of transition for people, their carers and their families.

9.27 Carers and families often assist people in making decisions about their care and how they pay for it. Local authorities should as appropriate invite carers and/or families to participate in discussions, and should also provide them with all the information that would otherwise be given to the person they care for, subject (where required)[footnote 29] to the consent of the person with care and support needs (if they have capacity) or someone else with appropriate authorisation. In doing this, they must ensure compliance with mental capacity and data protection legislation, and the other duties pertaining to information and advice set out in chapter 3 of this guidance.

9.28 As a deferred payment agreement can take some time to set up and agree, it is important that both the local authority and the individual consider any potential issues around mental capacity. Where a person may lack capacity to request a deferred payment, a deputy or attorney (a person with a relevant enduring power of attorney or lasting power of attorney) may request a deferred payment on their behalf. If a family member requests a deferred payment and they do not have the legal power to act on behalf of the person, then the person and the family member should receive information and advice on how to obtain this, through lasting power of attorney and deputyships. Where the local authority is the deputy for a person, then the local authority deputy may apply for deferred payments where this is in the best interests of the person. Local authorities must not enter into deferred payment agreements with a person lacking the requisite mental capacity unless the proper arrangements are in place.

9.29 Local authorities and the person applying for a deferred payment (who has capacity) may also want to consider any potential issues around loss of capacity. The local authority should where appropriate provide the person with information and advice on options for deputyship, legal power of attorney and advocacy. If a local authority and the person do discuss the issue, the local authority should confirm what would happen were the person to lose capacity and not have made their own arrangements. Further advice on capacity and financial arrangements is contained in the guidance on debt recovery in Annex D (a deferred payment being effectively a consensually-accruing debt to the local authority).

9.30 If a local authority identifies someone who may benefit from or be eligible for a DPA or a person approaches them for information, the local authority must tell them about the DPA scheme and how it works. This explanation should, at a minimum:

set out clearly that the fees are being deferred or delayed and must still be paid back at a later date, for example through the sale of the home (potentially after the individual's death)

explain the types of security that a local authority is prepared to accept (as set out by each local authority in a publicly - available policy; see the section entitled 'Obtaining Security' below for further details)

explain that if a home is used as security, the home may need to be sold at a later date to repay the amount due

explain that the total amount they can defer will be governed by an equity limit (discussed in the section entitled 'How much can be deferred' below) which may change if the value of their security changes

explain the circumstances where the local authority may cease to defer further amounts (such as when the person qualifies for local authority support in paying for their care), and the circumstances where the local authority has to stop deferring further amounts (such as when the person reaches their equity limit)

explain if and how interest will be charged on any amount deferred

explain that they may be liable to pay administrative charges

explain what happens on termination of the agreement, how the loan becomes due and their options for repayment

explain what happens if they do not repay the amount due

set out the qualifying criteria for a DPA

detail the requirements that must be adhered to during the course of the DPA

explain the implications that a deferred payment agreement may have on their income, their benefit entitlements, and charging

provide an overview of some potential advantages and disadvantages of taking out a DPA, and explain that there are other options for paying for their care that they may wish to consider

note the existence of the 12-week disregard, which will afford those who qualify for it some additional time to consider their options in paying for care

suggest that people may want to consider taking independent financial advice (including flagging the existence of regulated financial advice), in line with the guidance set out in chapter 3

9.31 Local authorities should provide easy to read information about how the scheme works. This may be in the form of a standardised information sheet.

9.32 Local authorities must provide this information and advice in formats that ensure compliance with the requirements of the Equality Act 2010 (in particular, they must ensure where appropriate that the information is accessible to the sensory impaired, people with learning disabilities, and people for whom English is not their first language). Further clarifications on information and advice requirements are detailed in chapter 3.

9.33 Where relevant, local authorities should provide information and advice on DPAs at the earliest appropriate opportunity during the period of the 12-week disregard[footnote 28]. Local authorities should aim to ensure that people are able to make a smooth transition from the 12-week disregard to the DPA if they opt to enter into an agreement. This means ensuring as far as possible that a DPA is available by the first day of week 13.

9.34 Local authorities should advise people (where appropriate) that they will need to consider how they plan to use, maintain and insure their property if they take out a DPA; that is whether they wish to rent, to prepare for sale, or to leave it vacant for a period. The local authority should advise if it intends to place conditions on how the property is maintained whilst the DPA is in place (authorities will usually include requirements for people to maintain and insure their homes in the terms and conditions of a deferred payment agreement; see the section entitled 'Making the Agreement' for further details).

9.35 Local authorities should develop basic information and advice for homeowners on how they may choose to use their property when they enter care, for example information on how they may go about renting their property, and the potential impact on other people living in the property if a sale is required after their death. They should signpost people to more specialist organisations who can provide further advice on this issue, including information about their legal responsibilities as landlords and their obligations to any potential tenants.

Case study 2

Lucille's son Buster has been providing informal care and support to her, and has heard of the deferred payments scheme. When Lucille decides she may benefit from a care home placement, her son suggests they approach her local authority together for information and advice about deferred payment agreements.

Her local authority provides them both with a printed information sheet setting out further details on the authority's deferred payment scheme, and also provides them with contact details of some national and local services who provide financial information and advice

Lucille is interested in renting her property whilst residing in a care home. The local authority has an existing housing advice service, so signposts Lucille to them for further advice on lettings. The local authority's standard information sheet also includes information on how her rental income may be used to pay for her care and support.

How much can be deferred?

9.36 In principle, a person should be able to defer the entirety of their care costs; subject to any contribution the local authority is allowed to require from the person's income. The local authority will need to consider whether a person can provide adequate security for the deferred payment agreement (see next section entitled 'Obtaining Security' - usually this requirement for 'adequate security' will be fulfilled by securing their deferred payment agreement against their property).

9.37 If the person is considering a top-up, the local authority should also consider whether the amount or size of the deferral requested is sustainable given the equity available from their chosen form of security. A discussion of sustainability may be helpful in all cases to ensure the person is aware of how much care their chosen form of security would afford them.

9.38 Three elements will dictate how much a person will defer, each of which is discussed below:

1. a) The amount of equity a person has available in their chosen form of security (usually their property)

2. b) The amount a person is contributing to their care costs from other sources, including income and (where they choose to) any contribution from savings, a financial product or a third-party

3. c) The total care costs a person will face, including any top-ups the person might be seeking

9.39 Local authorities should also satisfy themselves that any top-up they agree to is sufficiently sustainable. Some guidance for local authorities in assessing whether a top-up is sustainable is provided below.

Equity Limit

9.40 When considering the equity available, local authorities must be guided by an 'equity limit' for the total amount that can be deferred and ensure that the amount deferred does not rise above this limit. The equity limit will leave some equity remaining in the security used for the DPA - this will both act as a buffer to cover any subsequent interest which continues to accrue, and will provide a small 'cushion' in case of small variations in value of the security. In the majority of cases a property will be used as security, so the equity limit will provide a cushion against changes in house prices. When calculating progress towards the equity limit, the local authority must also include any interest and/or fees to be deferred.

9.41 If the person intends to secure their deferred payment agreement with a property, local authorities must obtain a valuation of the property. Reasonable property valuation costs are included in the list of administration charges that local authorities can pass on to people, should they wish to do so. People may request an independent assessment of the property's value (in addition to the local authority's valuation). If an independent assessment finds a substantially differing value to the local authority's valuation, the local authority and person should discuss and agree an appropriate valuation prior to proceeding with the agreement.

9.42 Where a property is used as security to offer a deferred payment agreement, the equity limit must be set at the value of the property minus 10%, minus £14,250 (for financial year 2015 to 2016, this is in line with the lower capital limit) and the amount of encumbrance secured on it. This limit provides some protection to local authorities against changes in the value of the security (such as possible house price fluctuations) and the risk that they may not be able to recoup the full amount owed, but also should mean that people qualify for local authority support if they deplete the equity available in their property (and are consequently not at risk of having to sell their home to pay for care).[footnote 29]

9.43 Local authorities should, when someone is approaching or reaches the point at which they have deferred 70% of the value of their chosen security, review the cost of their care with the person, discuss when the person might be eligible for any means tested support, discuss the implications for any top-up they might currently have, and consider jointly whether a deferred payment agreement continues to be the best way for someone to meet these costs.

9.44 The following example illustrates the equity limit principle.

Case study 3: The equity limit

Lucille decides to secure her deferred payment agreement with her house, which is worth £165,000. The amount of equity available will be the value of the property minus 10%, minus a further £14,250 (the lower capital limit).

£165,000 - £16,500 - £14,250 = £134,250

Therefore, her 'equity limit' for the total amount she could defer would consequently be £134,250, which would leave £30,750 in equity in her home.

9.45 Local authorities must not allow additional amounts to be deferred beyond the equity limit, and must refuse to defer care costs beyond this (see section above entitled 'permission to refuse'). However, interest can still accrue beyond this point, and administrative charges can still be deferred.

Contributing to care costs from other sources

9.46 A person may meet the costs of their care and support from a combination of any of 4 primary sources:

9.47 The share of care costs that someone defers will depend on the amount they will be paying from the other sources listed above.

9.48 Local authorities may require a contribution towards care costs from a person's income, but the person has a right to retain a proportion of their income (the 'disposable income allowance'). The disposable income allowance is a fixed amount (up to £144 per week) of a person's income which the local authority must allow the person to retain (if the person wants to retain it). The local authority can require the person to contribute the rest of their income, but must allow the person to retain as much of their disposable income allowance as they want to.

9.49 A person may choose to keep less of their income than the disposable income allowance. This might be advantageous to the person as they would be contributing more to the costs of their care from their income, and consequently reducing the amount they are deferring (and accruing less debt to their local authority overall). However this must be entirely at the individual's decision and the local authority must not compel someone to retain less than the disposable income allowance if the person wants to retain the full amount.

9.50 If a person decides to rent out their property during the course of their DPA, a local authority should permit that person to retain a percentage of any rental income they possess. Local authorities may want to consider whether to offer other incentives to individuals to encourage rental of properties, though the decision as to whether or not to rent a property must be the person's and theirs alone.

9.51 A person may also contribute to their care costs from payments by a third party (including any contributions available from a financial product) or from their savings. Contributing to care costs from another source would be beneficial for a person as it would reduce the amount they are deferring (and hence reduce their overall debt to the local authority). A local authority must not compel a person to contribute to their deferral from these sources.

Case study 4

Lucille identifies a care home placement that meets her care and support needs, costing £540 per week. She has an income provided by her pension of £230 per week. Lucille decides not to rent her home as she intends to sell it within the year.

Based on this provisional estimate of her care costs, Lucille would contribute £86 (230 -144) per week from her income, and her weekly deferral would be £454.

Care costs

9.52 Before considering in detail how much they will be deferring, a person and usually the local authority should have a rough idea of their likely care costs as a result of the care planning process. Someone may wish to vary their care package (or any top-ups they may be considering) following consideration of what they could afford with a deferred payment agreement, but should approach the process with an approximate idea of what their care costs are likely to be.

9.53 In principle, people should be able to defer their full care costs including any top-ups.[footnote 32] At a minimum, when local authorities are required to offer a deferred payment agreement they must allow someone to defer their 'core' care costs. To ensure sustainability of the deferral, local authorities have discretion over the amount people are permitted to top-up.[footnote 33] Local authorities should consider any request for top-ups, but retain discretion over whether or not to agree to a given top-up. Local authorities should accept any top-up deemed to be reasonable given considerations of affordability, sustainability and available equity. Local authorities should be mindful of the duties set out in relation to top-ups and additional costs in the care and support and aftercare (Choice of Accommodation) regulations 2014.

Sustainability

9.54 When deciding on the amount to be deferred in a discretionary deferred payment agreement (particularly when considering top-ups), both parties should consider a range of factors to satisfy themselves that the arrangement is sustainable including:

the likely period the person would want a DPA for (if they intend to use it as a 'bridging loan');

the equity available

the sustainability of a person's contributions from their savings (if they are making one)

the flexibility to meet future care needs

the period of time a person would be able to defer their care costs for

9.55 Deferred payment agreements should prevent people from having to sell their home in their lifetime to pay for their care. Local authorities should discuss with the person the projected limit of what their equity could cover, given their projected care costs, and how their care costs might change over time. This may include a discussion of when they are likely to reach any of the income thresholds and may begin to qualify for local authority support in paying for their care. If the person is requesting a top-up, it is important that the local authority discusses what might happen to any top-up requested if the person reaches the equity limit and moves on to local authority support in paying for their care, and ensures that a written agreement is in place (see Annex A: Choice of accommodation and additional payments). In particular, the local authority should make the person aware that once they have reached the equity limit, the local authority may not be willing to fund their top-up, and the person may need to find other ways to pay for it or be prepared for a change in their care package.

9.56 Local authorities and individuals should also consider the length of time that a person's intended contribution to care costs from savings would last, if they intend to contribute to their care costs from their savings. This should include consideration of the impact on their care if a person's savings are depleted (normally this would involve increasing the amount the person is deferring).

9.57 An important factor in the sustainability of a deferred payment agreement will be any future care and support needs someone might face, and local authorities and people should consider allowing flexibility for changes in circumstance, including possible escalations of needs, when deciding how much someone should defer. Local authorities and people should factor any potential changes in circumstances into their considerations of sustainability.

9.58 The department has developed a tool to aid local authorities in assessing sustainability. Local authorities may use this tool to aid discussions and decisions about the amount to be deferred, but local authorities retain final responsibility for (and have discretion over) decisions taken about the agreements they enter into.

9.59 When agreement has been reached between a person and the local authority as to how much they want to defer, the local authority must ensure this is clearly and unambiguously set out in the deferred payment agreement. Further details on what happens once an amount has been agreed are set out in the section entitled 'making the agreement' below.

9.60 The amount being deferred should be reviewed on a regular basis to ensure the deferred amount does not exceed the equity limit as discussed above.[footnote 32] Local authorities should have particular regard to the amount deferred as it approaches the equity limit.

9.61 Further details of local authorities' responsibilities during the course of the DPA are set out in the relevant section below.

Case study 5

Lucille discusses her care home fees with the local authority. Based on the equity available in her home (£134,250, as set out in Case study 3 above), Lucille could afford her weekly deferral of £454 for around 5 years. Given an average length of stay in a care home care of 19.7 months (source: BUPA 2010, cited in Laing and Buisson 2012/13), the local authority deems her projected care costs to be sustainable.

Lucille enquires as to the cost of a room with a garden view. This would increase her weekly deferral to £525 which she could afford for around four and a half years. The local authority deems this to be sustainable, so agrees to Lucille's requested top-up.

Obtaining security

9.62 A local authority must have adequate security in place when entering into a deferred payment agreement. The regulations set out one form of security that local authorities must accept, and also provide wider discretion for local authorities to accept other forms of security as they see fit. Local authorities should consider whether another type of security could be provided if a person cannot secure their deferred payment agreement with a charge on a property.

9.63 One form of 'adequate security' would be the local authority securing a first legal mortgage charge against a property on the Land Register. Local authorities must accept a first legal mortgage charge as adequate security and local authorities must offer a deferred payment to someone who meets the qualifying criteria for the scheme where the local authority is able to secure a first legal mortgage charge on the property.

9.64 In cases where an agreement is to be secured with a jointly-owned property, local authorities must seek both owners' consent (and agreement) to a charge being placed on the property. Both owners will need to be signatories to the charge agreement, and the co-owner will need to agree not to object to the sale of the property for the purpose of repaying the debt due to the local authority (following the same procedure as in the case where an individual is the sole owner of a property).

9.65 The local authority must obtain similar consent to a charge being created against the property from any other person who has a beneficial interest in the property.

9.66 Under the discretionary scheme, local authorities have discretion to decide what else may constitute 'adequate security' for a deferred payment agreement, in cases where a first charge cannot be secured. A local authority's decision should be based on an explicit and publicly-accessible policy of what other types of security they are willing to consider in addition to a first charge, but local authorities may consider the merits of each case individually. Other forms of security a local authority may choose to consider include (but are not limited to):

9.67 A local authority has full discretion in individual cases to refuse a deferred payment agreement if it is not satisfied that adequate security is in place.[footnote 33]

9.68 The security should also be revalued when the amount deferred equals or exceeds 50% of the value of the security to assess any potential change in the value (and consequently the person's 'equity limit' should be reassessed in turn). After this revaluation, local authorities should revalue the security periodically to monitor any potential further changes in value. If in either case there has been any substantial change the local authority should review the amount being deferred as well, as set out in the section 'how much can be deferred' above.

Interest rate and administration charge

9.69 The deferred payment agreement scheme is intended to be run on a cost-neutral basis, with local authorities able to recoup the costs associated with deferring fees by charging interest. Local authorities can also recoup the administrative costs associated with DPAs, including legal and ongoing running costs, via administration charges which can be passed on to the individual. Administration charges and interest can be added on to the total amount deferred as they are accrued, although a person may request to pay these separately if they choose. The agreement must make clear that all fees deferred, alongside any interest and administrative charges incurred, must be repaid by the person in full. The local authority must also notify the individual in writing whenever they are liable for an administration charge.

9.70 Local authorities will have the ability to charge interest on any amount deferred, including any administration charge deferred. This is to cover the cost of lending and the risks to local authorities associated with lending, for example the risk of default. Where local authorities charge interest this must not exceed the maximum amount specified in regulations. A local authority may (but is not required to) charge the nationally-set maximum interest rate. The same interest rate must be charged on all deferred payments within a local authority.[footnote 34]

9.71 The national maximum interest rate will change every 6 months on 1st January and 1st July. It will track the market gilts rate specified in the most recently published report by the Office of Budget Responsibility ( OBR) plus a 0.15% default component. For example, gilt rate 1% plus 0.15% equals a maximum interest rate of 1.15%. The market gilt rate is currently published in the Economic and Fiscal Outlook, which is usually published twice-yearly on the OBR website. The figures can be found in the 'Determinants of the fiscal forecast' table, in the Economic and Fiscal Outlook.

Local authorities must ensure that any changes to the national maximum rate are reflected within their authority and are applied to any agreements they have entered into (unless they are already charging less than the national maximum). Individual agreements must also contain adequate terms and conditions to ensure that the interest rate within any given agreement does not exceed the nationally set maximum.

9.72 In extremely rare circumstances (such as a severe economic shock), government may need to make new regulations to change the maximum interest rate which local authorities are permitted to charge before the next January or July change date. These powers would only be exercised as a last resort.

9.73 Local authorities must inform people before they make the agreement if interest will be charged, what interest rates are currently set at, and when interest rates are likely to change. This is to enable people to make well-informed decisions about whether a deferred payment agreement is the best way for them to meet the costs of their care.

9.74 The interest charged and added to the deferred amount will be compounded, and local authorities should ensure when making the agreement that individuals understand that interest will accrue on a compound basis.

9.75 Interest can accrue on the amount deferred even once someone has reached the 'equity limit' (see 'how much can be deferred' above). It can also accrue after someone has died up until the point at which the deferred amount is repaid to the local authority. If the local authority cannot recover the debt and seeks to pursue this through the County Court system (as discussed in Annex D on debt recovery), the local authority may charge the higher County Court rate of interest.

9.76 Local authorities must set their administration charge at a reasonable level, and this level must not be more than the actual costs incurred by the local authority in provision of the Universal Deferred Payment Scheme, as set out in regulations. Relevant costs may include (but are not limited to) the costs incurred by a local authority whilst:

9.77 Local authorities should maintain a publicly-available list of administration charges that a person may be liable to pay. It is good practice to separate charges into a fixed set-up fee for deferred payment agreements, reflective of the costs incurred by the local authority in setting up and securing a typical deferred payment agreement, and other reasonable one-time fees during the course of the agreement (reflecting actual charges incurred in the course of the agreement).

Making the agreement

9.78 Where someone chooses to enter into a deferred payment agreement, local authorities should aim to have the agreement finalised and in place by the end of the 12-week disregard period (where applicable) (see Annex B: Treatment of capital), or within 12 weeks of the person approaching the local authority regarding DPAs in other circumstances.

9.79 Decisions on a person's care and support package, the amount they intend to defer, the security they intend to use and the terms of the agreement should only be taken following discussion between the local authority and the individual. Once agreement in principle has been reached between the local authority and the person, it is the local authority's responsibility to transpose the details agreed into a deferred payment agreement, taking the legal form of a contract between the local authority and the person.

9.80 The local authority should provide a hard copy of the deferred payment agreement to the person, and they should be provided with reasonable time to read and consider the agreement, including time for the individual to query any clauses and discuss the agreement further with the local authority.

9.81 The agreement must clearly set out all terms, conditions and information necessary to enable the person to ascertain his or her rights and obligations under the agreement. These include:

1. a) terms to explain how the interest will be calculated and that it will be compounded if it is to be added to the deferred amount

2. b) information as to administrative costs the individual might be liable for

3. c) terms to explain how the adult may exercise his or her right to terminate the agreement, which should explain the process for and consequences of terminating the agreement and specify what notice should be given (see the section entitled 'terminating the agreement' below)

4. d) terms to explain the circumstances in which the local authority might refuse to defer or loan further fees (either when it is required to stop, for example if the person has already reached their 'equity limit', or when it has powers to stop, such as when a person qualifies for local authority support in paying for their care; as set out in the 'how much can be deferred' and 'permission to refuse' sections above)

5. e) that the local authority will secure their debt either by placing a legal (Land Registry) charge against the property, or by some other means specified

6. f) a term requiring the local authority to provide the person with a written statement every 6 months and within 28 days of request by the person, setting out how much the person owes to the authority and the cost to them of repaying the debt

7. g) a term which explains that the maximum amount which may be deferred is the equity limit and that this is likely to vary over time

8. h) a term which requires the local authority to give the adult 30 days written notice of the date on which they are likely to reach the equity limit

9. i) a term which requires the adult to obtain the consent of the local authority for any person to occupy the property

10. j) an explanation that the local authority will stop deferring its charges and making advances under a loan agreement if the person no longer receives care and support in a care home or supported living accommodation or if the local authority no longer considers that the adult's needs should be met in such accommodation

9.82 If the agreement is not for the deferral of charges due to the authority (that is, a loan-type agreement), the agreement must also contain:

1. a) a term to make clear that the authority will make advances of the loan to the adult in instalments

2. b) a term to make clear that the purpose of the loan is to pay for costs of care and support in a care home or supported living accommodation. This should explain:

1. (i) the consequences of any failure by the adult to pay those costs of care and support; and

2. (ii) that the adult must inform the local authority if he or she no longer receives or intends to receive care in such accommodation.

9.83 The agreement should also stipulate:

1. a) the value of any accrued or possible administrative charges, and where possible a breakdown of their calculation

2. b) the means of redress if either party feels the other has broken the terms of the agreement

3. c) the person's responsibilities regarding maintenance and insurance of their home

4. d) the person's responsibility to notify the local authority of any change to their income, home or care and support

5. e) the person's responsibility to notify the local authority if they intend to rent or sell their property and if someone has gained or may gain a beneficial interest in their property

6. f) the local authority's responsibility to give the person 30 days written notice if it intends to cease to defer charges (or make loan instalments) under the agreement

7. g) a clear explanation of the consequences of taking out a DPA for the person and their property, including anybody who may reside in the property

8. h) the equity limit of their security (as discussed above in the section entitled 'how much can be deferred') and the scope for this to change upon revaluation of the security used for the DPA

9. i) the process for varying any part of the agreement

10. j) the process by which the local authority can require a re-valuation of a person's chosen form of security

9.84 Local authorities should ensure at a minimum that people sign or clearly and verifiably affirm they have received adequate information on options for paying for their care, that they understand how the DPA works and understand the agreement they are entering into; and that they have had the opportunity to ask questions about the contract. A term reflecting this should be included in the agreement itself.

9.85 Local authorities will need to consider whether the deferred payment agreements they enter into are regulated credit agreements to which the Consumer Credit Act 1974 ( CCA) and Financial Services and Markets Act 2000 ( FSMA) apply.

9.86 The scope of 'regulated credit agreements' is set out in article 60B of the Financial Services and Markets Act 2000 (Regulated Activities) Order 2001 ( RAO). A credit agreement is regulated unless exempt, and there are a number of exemptions in articles 60C to 60H of the RAO. It is likely that most DPAs will fall within such an exemption. If the agreement is regulated, it will need to comply with all applicable requirements of the CCA. In addition, the local authority will need a relevant permission from the Financial Conduct Authority ( FCA), and to comply with the FCA's rules and principles, unless the exclusion in article 72G of the RAO applies ( if the credit agreement is within the scope of the Consumer Credit Directive FCA authorisation is required).

9.87 All deferred payment agreements will be subject to the Unfair Terms in Consumer Contracts Regulations 1999, so the terms will have to be written in plain, intelligible English and will not be binding if they are unfair to the borrowers. Local authorities will also have to ensure that they do not contravene the Consumer Protection from Unfair Trading Regulations 2008.

The local authority's responsibilities whilst the agreement is in place

9.89 Local authorities must at a minimum provide people with 6-monthly written updates of the amount of fees deferred, of interest and administrative charges accrued to date, and of the total amount due and the equity remaining in the home (the 'equity limit' discussed in the section entitled at 'how much can be deferred' above). Local authorities should also provide the person with a statement on request within 28 days. Local authorities may provide updates on a more frequent basis at their discretion. The update should set out the amount deferred during the previous period, alongside the total amount deferred to date, and should also include a projection of how quickly someone would deplete all equity remaining in their chosen form of security up to their equity limit.

9.90 Local authorities should reassess the value of the chosen form of security once the amount deferred exceeds 50% of the security (and periodically thereafter), and adjust the equity limit and review the amount deferred if the value has changed.

9.91 Local authorities may offer people a way to check their statement at any point in the year via an online facility.

9.92 Local authorities may choose to develop advice and guidance around maintaining a home, renting, and income. Local authorities may also offer services/ products to help the person meet the requirements for maintenance and insurance, but cannot compel a person to take on their product. Local authorities must accept reasonable alternative maintenance and insurance services.

Case study 6:

For illustrative purposes, we have used an interest rate of 3.5%. After 6 months, Lucille receives her first statement. It confirms she has deferred a total of £13,900, including £110 in interest and £100 in administration fees.

At this point, the local authority revalues her property and finds its value has increased to £170,000. Based on the amount deferred and her care costs, her equity would afford her just over 4 and a half more years' care at this price.

Contractual responsibilities on the individual whilst the agreement is in place

9.93 The deferred payment agreement sets out various contractual requirements on the individual as well as on the local authority. These are set out briefly in sections above, but the person's consequent responsibilities are recapped in more detail in the paragraphs below.

9.94 If the local authority is exercising its right to require the adult to make a contribution from income, it should include in the legal agreement provisions requiring the person to notify the local authority of any changes in their income.

9.95 The agreement should also contain provisions requiring the adult to notify the authority of changes in their need for care and support, if those changes are ones which will mean that the authority must or is entitled to stop making further instalments under the agreement or to alter the amount of the instalments.

9.96 Similarly if the agreement has been entered into on the basis that the adult's property has not been disregarded for the purposes of the financial assessment in section 17 and it is a term of the agreement that the local authority will cease making or reduce the amount of instalments it makes, the agreement should require the person to inform the authority of changes which mean that the property may be disregarded.

9.97 The local authority should include in a contract provisions requiring someone to ensure that appropriate arrangements are in place to maintain their home whilst they are in care. In particular, the contract should require that their home is maintained adequately, and require someone to have in place an arrangement for regular maintenance to take place. Local authorities should also require the person to have adequate insurance for their property. If their home is to be left empty for an extended period of time, the person will need to ensure their insurance covers this adequately and that any terms required by the insurer are met.

9.98 The local authority must include in a contract provisions which require the person to obtain the authority's consent before allowing someone to move into the property after the agreement has been made. In these circumstances, the local authority may (if it is reasonable to do so) require written consent from the person which places the debt owed to the local authority above any beneficial interest they may accrue in the property.

Termination of agreement

9.99 A deferred payment agreement can be terminated in 3 ways:

1. a) at any time by the individual, or someone acting on their behalf, by repaying the full amount due (this can happen during a person's lifetime or when the agreement is terminated through the deferred payment agreement holder's death)

2. b) when the property (or form of security) is sold and the authority is repaid [see note 6]

3. c) when the person dies and the amount is repaid to the local authority from their estate

Note 6

In the case that a deferred payment agreement is agreed on the basis of a form of security other than property, local authorities will need to make provision in the agreement for conclusion of the deferred payment agreement in the event that the given security is disposed of/comes to fruition.

9.100 All 3 scenarios for the termination of the agreement are discussed below, alongside the various options for repayment. On termination, the full amount due (including care costs, any interest accrued and any administrative or legal fees charged) must be paid to the local authority.

9.101 If a person decides to sell their home, they should notify the local authority during the sale process. They will be required to pay the amount due to the local authority from the proceeds of the sale, and the local authority will be required to relinquish the charge on their property.

9.102 A person may decide to repay the amount due to the local authority from another source, or a third party may elect to repay the amount due on behalf of the individual. In either case, the local authority should be notified of the person's/the third party's intention in writing, and the local authority must relinquish the charge on the property on receipt of the full amount due.

9.103 If the deferred payment is terminated due to the person's death, the amount due to the local authority must be either paid out of the estate or paid by a third party. A person's family or a third party may wish to settle the debt to the local authority by other means of repayment (as may be the case if the family wanted to avoid having to sell the property or means of security), and the local authority must accept an alternative means of payment in this case, provided this payment covers the full amount due to the local authority.

9.104 The executor of the will or administrator of the estate can decide how the amount due is to be paid; either from the person's estate (usually via the sale of the house or potentially via a life assurance policy) or from a third party source.

9.105 A local authority should wait at least 2 weeks following the person's death before approaching the executor with a full breakdown of the total amount deferred (but a family member or the executor can approach the local authority to resolve the outstanding amount due prior to this point).

9.106 Responsibility for arranging for repayment of the amount due (in the case of payment from the estate) falls to the executor of the will.

9.107 Interest will continue to accrue on the amount owed to the local authority after the individual's death and until the amount due to the local authority is repaid in full.

9.108 If terminated through a person's death, the amount owed to a local authority under a deferred payment agreement falls due 90 days after the person has died. After this 90-day period, if a local authority concludes active steps to repay the debt are not being taken, for example if the sale is not progressing and a local authority has actively sought to resolve the situation (or the local authority concludes the executor is wilfully obstructing sale of the property), the local authority may enter into legal proceedings to reclaim the amount due to it. Further information on debt recovery is included at Annex D of this guidance.

9.109 In whichever circumstance an agreement is terminated, the full amount due to the local authority must be repaid to cover all costs accrued under the agreement, and the person (and/or the third party where appropriate) must be provided with a full breakdown of how the amount due has been calculated. Once the amount has been paid, the local authority should provide the individual with confirmation that the agreement has been concluded, and confirm (where appropriate) that the charge against the property has been removed.

Person-centred care and support planning

This section includes chapters 10 to 13 and has information on:

10. Care and support planning

This chapter provides guidance on sections 24 and 25 of the Care Act 2014, and includes:

when to undertake care and support planning

what it means to 'meet needs', and considerations in deciding how to meet needs

how to undertake care and support planning, and support planning

production of the plan

Involving the person

authorising others (including the person) to prepare the plan

care planning for people who lack capacity

minimising and authorising a deprivation of liberty (DOL) for people who lack capacity

combining plans

sign-off and assurance

protecting property of adults being cared for away from home

10.1 Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan or support plan in the case of carers (henceforth referred to as 'the plan').

10.2 The person must be genuinely involved and influential throughout the planning process, and should be given every opportunity to take joint ownership of the development of the plan with the local authority if they wish, and the local authority agrees. There should be a default assumption that the person, with support if necessary, will play a strong pro-active role in planning if they choose to. Indeed, it should be made clear that the plan 'belongs' to the person it is intended for, with the local authority role being to ensure the production and sign-off of the plan to ensure that it is appropriate to meet the identified needs.

10.3 The personal budget in the plan will give everyone clear information regarding the costs of their care and support and the amount that the local authority will make available, in order to help people to make better informed decisions as to how needs will be met. The ability to meet needs by taking a direct payment must be clearly explained to the person in a way that works best for them, so that they can make an informed decision about the level of choice and control they wish to take over their care and support. This should mean offering the choice more than once in the process and enabling that choice by providing examples of how others have used direct payments, including via direct peer support, for example from user-led organisations.

10.4 Some people will need assistance to make plans and decisions, and to be involved in the planning process. The modern care and support system should routinely enable supported decision making, where options and choices are presented simply and clearly. Independent advocates (if used) must be instructed early in the assessment and planning process for those who have substantial difficulty in engaging with the care system, and have no other means of accessing appropriate support through friends or relatives to facilitate their involvement. If the person's substantial difficulty only becomes apparent during the assessment, an advocate must be instructed as soon as this becomes known (see chapter 7).

10.5 Ultimately, the guiding principle in the development of the plan is that this process should be person-centred and person-led, in order to meet the needs and achieve the outcomes of the person in ways that work best for them as an individual or as part of a family. Both the process and the outcomes should be built holistically around people's wishes and feelings, their needs, values and aspirations, irrespective of the extent to which they choose or are able to actively direct the process.

Definitions

10.6 This chapter applies to people in need of care and support and carers equally, unless specifically stated. It should be read in conjunction with the other chapters in this section (personal budgets, direct payments and review of care plans).

10.7 Unless otherwise stated, this chapter (and subsequent chapters in the section of 'Person Centred Care and Support Planning') applies to everyone whose needs are being met by the local authority, regardless of the setting in which the needs are met. For example, people in care homes must also receive a care and support plan and personal budget.

10.8 For the purposes of this chapter 'the plan' means either the care and support plan (in the case of adults with care and support needs) or the support plan (in the case of carers). When to undertake care and support planning, and support planning

10.9 Following the needs and carer's assessment and determination of eligibility (see chapter 6), a plan must be provided where a local authority is required to meet needs under section 18 or 20(1) of the Care Act, or decides to meet needs under section 19(1) or (2) and 20(6) of the Act. Where a local authority is required to meet needs under section 117 of the Mental Health Act 1983 this chapter should be read in conjunction with chapter 34 of the Mental Health Act 1983 Code of Practice (on the Care Programme Approach) and Refocusing the Care Programme Approach.

What does it mean to 'meet needs'?

10.10 'Meeting needs' is an important concept under the Act and moves away from the previous terminology of 'providing services'. This enables a greater variety of approaches in how needs can be met, developed through care and support planning as described in this chapter. The concept of 'meeting needs' is intended to be broader than a duty to provide or arrange a particular service. Because a person's needs are specific to them, there are many ways in which their needs can be met. The intention behind the legislation is to encourage this diversity, rather than point to a service or solution that may be neither what is best nor what the person wants. The purpose of the care and support planning process is to agree how a person's needs should be met, and therefore how the local authority will discharge its duty, or its power, to do so.

10.11 There are a number of broad options for how needs could be met, and the use of one or more of these will depend on the circumstances. Section 8(2) of the Act gives some examples of ways of meeting needs, and would cover:

10.12 Where the local authority provides or arranges for care and support, the type of support may itself take many forms. These may include more traditional 'service' options, such as care homes or homecare, but may also include other types of support such as assistive technology in the home or equipment/adaptations, and approaches to meeting needs should be inclusive of less intensive or service-focused options.

10.13 Needs may be met through types of care and support which are available universally, including those which are not directly provided by the local authority. For example, in some cases needs could be met by a service which is also made available as part of a local authority's plans for preventing or reducing needs for care and support (under Section 2 of the Act). Needs could also be met, for example, by putting a person in contact with a local community group or voluntary sector organisation.

10.14 The examples of how needs can be met listed in the Act are not exhaustive, but cover the most common means of meeting needs. In addition, there are other methods which may be suitable for meeting a person's needs, for example by arranging an individual service fund (see chapter 11 on personal budgets which also includes detail on individual service funds). This is a budget held by a provider, rather than by the local authority or the individual. The local authority makes a payment to the provider, which then holds a budget over which the individual has control.

10.15 The local authority may also consider whether it can effectively meet a person's needs by 'brokering' a service on behalf of an individual in certain cases. 'Brokering' services are commonly offered by organisations which are independent of the local authority, and may be accessed by any person wishing to find care. However, the local authority may also provide such support where it meets a person's needs. 'Brokering' would involve the local authority supporting an individual to make a choice about the provider of their care, and to enter into a contract with that provider. The local authority would not need to hold the contract with the provider, but would be required to assure itself that the chosen provider and terms of the contract were appropriate to meet the person's needs.

10.16 The local authority would remain under the duty to meet a person's eligible needs, and so would need to be satisfied both that this was an effective way of meeting those needs, and that the person was in agreement to this approach being used. It is likely that 'brokering' would only be an effective way of meeting a person's needs in exceptional circumstances, for example where a person is fully funding their own care and wishes to retain control of the contract with their provider, but wants the local authority to meet their needs and the local authority has agreed to do so. If there is a risk that a person's needs would not be met effectively by means of 'brokering', the local authority should discount it as an option and proceed with other ways of meeting that person's needs, such as direct commissioning of services from a provider. In considering such an option, the local authority should also have regard to the likelihood of the person continuing to be willing and able to manage such arrangements in the future, including their ability to pay the charges due (for example, to mitigate against a future loss of capacity or disposal of their assets, such that the local authority may be required to take over the contract with the provider). The local authority would continue to support the person in meeting any other needs, offering ongoing support and keeping the arrangements under review to ensure that the needs were met. The person would have a care and support plan as usual.

10.17 The individual's position in this approach would in some respects be akin to a person who had taken a direct payment to commission their own services, in that they would hold their own contract with a provider whilst the local authority is under a duty to meet their needs.

10.18 The difference would be that in the case of a direct payment, the money for commissioning the service comes from the local authority, whereas in the case of 'brokering' it comes from the individual directly. This option, therefore, would only likely be of use for meeting the needs of people who are fully funding their own care but ask the local authority to meet their eligible needs, and who are not using alternative arrangements such as an individual service fund.

Case study: Using discretionary powers to meet needs

Mrs Pascal, who is frail and elderly, was admitted to hospital after a fall. The hospital has established that Mrs Pascal currently has no care and support plan in place and made contact with the local authority to arrange a needs assessment. The local authority assesses that she has eligible needs which will be best met in a care home setting.

The local authority undertakes a financial assessment which finds that Mrs Pascal's finances are above the limit for financial support from the local authority. The authority provides her with information and advice about her options. Mrs Pascal expresses extreme nervousness about seeking a placement on her own as she has struggled with managing her personal finances in recent times and does not have any family who are able to support her.

After a consultation, both Mrs Pascal and her local authority agree that support with arranging and managing a care placement would be beneficial for her wellbeing and would adequately meet her eligible needs. The authority arranges for Mrs Pascal to meet a trusted brokerage organisation which discusses her needs and arranges a contract with a care home on behalf of Mrs Pascal that she is very happy with.

Considerations in meeting needs

10.19 However the local authority is meeting needs, the principles in this chapter should be followed, such as ensuring the process is person-centred, and involving and taking all reasonable steps to agree the plan with the person.

10.20 The local authority must take into consideration the individual's preferences. The authority should consider the person's goals in approaching the authority for support, and the level or nature of support desired. Where the person wishes to take more control over their own care and support, this should be reflected in the route taken. Similarly, where the person asks for more local authority support (for example, because they lack the skills or confidence to engage with the provider market and do not have family or friends who are willing and/or able to support them with this), the authority should respond accordingly in the decision taken about how needs will be met.

Relationship with other services

10.21 Local authorities should also have regard to how needs may be met beyond the provision, or arrangement, of services by the authority. A person may already be in receipt of care and support which meets their needs (whether self-funded and arranged or not). For example, needs may be met by a carer, in an educational establishment or by another institution other than the local authority. In these circumstances the local authority remains under a duty to meet the person's eligible needs. If however, the alternative means of meeting the needs is in place and the authority is satisfied that this alternative means is, in fact, meeting the person's eligible needs, then the authority may not actually have to arrange or provide any services to comply with that duty.

10.22 However, the local authority should nonetheless record those needs through the assessment process, determine whether the needs meet the eligibility criteria and keep under review whether the authority needs to do anything in order to comply with its duty to meet the person's eligible needs (for example, if the alternative services being provided to meet the needs cease or the authority is no longer satisfied that the alternative services adequately meet the person's needs).

10.23 Sections 21 to 23 of the Act set out the limitations on the circumstances in which local authorities may meet care and support needs. In particular, they make clear that local authorities must not meet needs by providing or arranging any health service or facility which is required to be provided by the NHS, or doing anything under the Housing Act 1996. The aim of these provisions is to avoid duplication in the provision of services and facilities, and provide clarity about the limits of care and support, and the circumstances in which care and support should be provided as opposed to health services or housing services (or vice versa).

10.24 There may be other services to which a person is entitled under other legislation (but which could also be provided as part of the provision of care and support), which a local authority is not specifically prohibited from providing under the Act. Where there is a risk of overlapping entitlements (for example, where 2 different organisations may be under a duty to provide a service in relation to the same needs), local authorities should take steps to support the individual to access the support to which they are entitled under other legislation. This may include, for example, helping the person to access some disability-related benefits and allowances. It may also include working with the housing authority to ensure that there is a clear process in place for access to disabled facilities grants to avoid the risk of duplication of work in meeting the same needs.

10.25 The duty to meet eligible needs is not discharged just because a person has another entitlement to a different service which could meet those needs, but of which they are not availing themselves. The needs remain 'unmet' (and so the local authority remains under a duty to meet them) until those needs are actually met by the relevant service bring provided or arranged. Local authorities should therefore consider how to inform and advise people on accessing any such entitlements at the earliest stage possible, as well as working collaboratively with other local services to share information.

Needs met by a carer

10.26 Local authorities are not under a duty to meet any needs that are being met by a carer. The local authority must identify, during the assessment process, those needs which are being met by a carer at that time, and determine whether those needs would be eligible. But any eligible needs met by a carer are not required to be met by the local authority, for so long as the carer continues to do so. The local authority should record in the care and support plan which needs are being met by a carer, and should consider putting in place plans to respond to any breakdown in the caring relationship.

Other considerations

10.27 In determining how to meet needs, the local authority may also take into reasonable consideration its own finances and budgetary position, and must comply with its related public law duties. This includes the importance of ensuring that the funding available to the local authority is sufficient to meet the needs of the entire local population. The local authority may reasonably consider how to balance that requirement with the duty to meet the eligible needs of an individual in determining how an individual's needs should be met (but not whether those needs are met). However, the local authority should not set arbitrary upper limits on the costs it is willing to pay to meet needs through certain routes - doing so would not deliver an approach that is person-centred or compatible with public law principles. The authority may take decisions on a case-by-case basis which weigh up the total costs of different potential options for meeting needs, and include the cost as a relevant factor in deciding between suitable alternative options for meeting needs. This does not mean choosing the cheapest option; but the one which delivers the outcomes desired for the best value.

Non-eligible needs

10.28 Where the local authority is not required to meet needs, it nonetheless may use its powers to meet any other needs. This may include, for example, meeting needs which are not 'eligible' (for example, those which do not meet the eligibility criteria), or meeting eligible needs in circumstances where the duty does not apply (for example, where the person is ordinarily resident in another area). Where the local authority exercises such a power to meet other needs, the same duties would apply regarding the next steps, and therefore a plan must be provided.

10.29 If the local authority decides not to use its powers to meet other needs, it must give the person written explanation for taking this decision, and should give a copy to their advocate if the person requests. If the person cannot request this, then a copy should be given to the person's advocate or appropriate individual if this in the best interests of the person. This explanation must also include information and advice on how the person can reduce or delay their needs in future. This should be personal and specific advice based on the person's needs assessment and not a generalised reference to prevention services or signpost to a general web-site. For example, this should involve consideration of alternative ways in which a person could reduce or delay their care and support needs, including signposting to support within the local community. Authorities may choose to provide this information after the eligibility determination, in which case this need not be repeated again. At whatever stage this is done, in all cases the person must be given a written explanation of why their needs are not being met. The explanation provided to the person must be personal to and should be accessible for the person.

10.30 Where a local authority is meeting some needs, but not others, a combination of the 2 approaches above must be followed. The person must receive a care and support plan for the needs the local authority is required, or decides to meet that accords to the Act and this guidance, and which also includes a tailored package of information and advice on how to delay and/or prevent the needs the local authority is not meeting. This information should be given to the person in a format accessible to them so they are clear what needs are being met by the local authority.

How to undertake care and support planning, and support planning

10.31 The plan must detail the needs to be met and how the needs will be met, and will link back to the outcomes that the adult wishes to achieve in day-to-day life as identified in the assessment process and to the wellbeing principle in the Act. This should reflect the individual's wishes, their needs and aspirations, and what is important to and for them, where this is reasonable. [footnote 37] This process is central to the provision of person-centred care and support that provides people with choice and control over how to meet their needs. The local authority should encourage creativity in planning how to meet needs, and refrain from judging unusual decisions as long as these are determined to meet needs in a reasonable way.

10.32 The guiding principle therefore is that the person be actively involved and is given every opportunity to influence the planning and subsequent content of the plan in conjunction with the local authority, with support if needed. Joint planning does not mean a 50:50 split; the person can take a bigger share of the planning where this is appropriate and the person wishes to do so. A further principle is that planning should be proportionate. The person should not be required to go through lengthy processes which limit their ability to be actively involved, unless there are very strong reasons to add in elements of process and decision-making. Wherever possible the person should be able to be fully involved in the development of their plan, and any revision if circumstances change, with minimum process.

Production of the plan

10.33 The plan should be person-centred, with an emphasis on the individual having every reasonable opportunity to be involved in the planning to the extent that they choose and are able. This requires the local authority to ensure that information is available in a way that is meaningful to the person, and that they have support and time to consider their options. A named contact or lead professional should be considered both as part of care planning, and in the final plan, so that the person knows how to contact the local authority. The planning choices offered should range from support for the person, to jointly develop their plan with the local authority alone or with their family, friends or whoever they may wish to involve (this might include web-based resources, written information and peer support), through to one-to-one support from a paid professional, such as a social worker which may be the same person who undertook the assessment.

10.34 Where the person has substantial difficulty in being actively involved with the planning process, and they have no family and friends who are able to facilitate the person's involvement in the plan, the local authority must provide an independent advocate to represent and support the person to facilitate their involvement (see chapter 7). Likewise, where a person with specific expertise or training in a particular condition (for example, deafblindness) has carried out the assessment, someone with similar knowledge (and preferably the same person to ensure continuity) should also be involved in production of the plan.

10.35 In ensuring that the process is person-centred, the local authority should ensure that any staff responsible for developing the plan with the person are trained in the Mental Capacity Act if appropriate, familiar with best practice, and that there is sufficient local availability of independent advocacy and peer support, including access to social work advice.

10.36 When developing the plan, there are certain elements that must always be incorporated in the final plan, [unless excluded by the Care and Support (Personal Budget Exclusion of Costs) Regulations 2014]. These are:

10.37 These requirements should not encourage lengthy process where this is not necessary, or fixed decisions that cannot be changed easily. The maximum flexibility should be incorporated to allow adjustment and creativity, for example by allowing people to include personal elements into their plan which are important to them (but which the local authority is not under a duty to meet), or by developing the plan in a format that works for the person rather than a standard template.

10.38 Consideration of the needs to be met should take a holistic approach that covers aspects such as the person's wishes and aspirations in their daily and community life, rather than a narrow view purely designed to meet personal care needs.

10.39 Consideration of needs should also include the extent to which the needs or a person's other circumstances may mean that they are at risk of abuse or neglect. The planning process may bring to light new information that suggests a safeguarding issue, and therefore lead to a requirement to carry out a safeguarding enquiry (see chapter 14). Where such an enquiry leads to further specific interventions being put in place to address a safeguarding issue, this may be included in the care and support plan.

10.40 In considering the person's needs and how they may be met, the local authority must take into consideration any needs that are being met by a carer. The person may have assessed eligible needs which are being met by a carer at the time of the plan - in these cases the carer must be involved in the planning process. Provided the carer remains willing and able to continue caring, the local authority is not required to meet those needs. However, the local authority should record the carer's willingness to provide care and the extent of this in the plan of the person and also the carer, so that the authority is able to respond to any changes in circumstances (for instance, a breakdown in the caring relationship) more effectively. Where the carer also has eligible needs, the local authority should consider combining the plans of the adult requiring care and the carer, if all parties agree, and establish if the carer requires an independent advocate.

10.41 Local authorities should have regard to how universal services and community-based and/or unpaid support could contribute to the factors in the plan, including support that promotes mental and emotional wellbeing and builds social connections and capital. This may require additional learning and development skills and competencies for social workers and care workers which local authorities should provide.

10.42 Authorities are free, and are indeed encouraged, to include additional elements in the plan where this is proportionate to the needs to be met and agreed with the person the plan is intended for. For example, some people may value having an anticipated review date built into their plan in order for them to be aware of when the review will take place. As detailed in the review chapter, it is the expectation that the plan is reviewed no later than every 12 months, although a light-touch review should be considered 6-8 weeks after the plan and personal budget have been signed off.

10.43 The plan should be proportionate to the needs to be met, and should reflect the person's wishes, preferences and aspirations. However, local authorities should be aware that a 'proportionate' plan does not equate to a light-touch approach, as in many cases a proportionate plan will require a more detailed and thorough examination of needs, how these will be met and how this connects with the outcomes that the adult wishes to achieve in day-to-day life.

10.44 For example, the person may have fluctuating needs, in which case the plan should make comprehensive provisions to accommodate for this, as well as indicate what contingencies are in place in the event of a sudden change or emergency. This should be an integral part of the care and support planning process, and not something decided when someone reaches a crisis point. Furthermore, specific consideration should be given to how planning is conducted in end of life care.

10.45 In all cases, additional content to the plan must be agreed with the adult and any other person that the adult requests, and should be guided by the person the plan is intended for. There should also be no restriction or limit on the type of information that the plan contains, as long as this is relevant to the person's needs and/or outcomes. It should also be possible for the person to develop their plan in a format that makes sense to them, rather than this being dictated by the recording requirements of the local authority.

Case study: Fluctuating needs

Miss S has Multiple Sclerosis and requires a frame or wheelchair for mobility. Miss S suffers badly with fatigue, but for the majority of the time she feels able to cope with daily life with a small amount of care and support. However, during relapses she has been unable to sit up, walk or transfer, has lost the use of an arm or lost hervision completely. This can last for a few weeks, and happens 2 or 3 times a year; requiring 24 hour support for all daily activities.

In the past, Miss S was hospitalised during relapses as she was unable to cope at home. However, for the past 3 years, she has received a care and support package that include direct payments which allows her to save up one month's worth of 24 hour care for when she needs it, and this is detailed in the care and support plan.

Miss S can now instantly access the extra support she needs without reassessment and has reassurance that she will be able to put plans in place to cope with any fluctuating needs. She has not been hospitalised since.

10.46 In developing the plan, the local authority must inform the person which, if any, of their needs may be met by a direct payment (see chapter 12). In addition to this, the local authority should provide the person (and/or their independent advocate or any other individual supporting the person, if relevant and if the person wishes this) with appropriate information and advice concerning the usage of direct payments, how they differ from traditional services, and how the local authority will administer the payment (for example an explanation of the direct payment agreement or contract, and how it will be monitored). This advice should also include detail such as:

10.47 This information provided upfront should assist the person to decide whether they wish to request a direct payment to meet some or all of their needs and should also be available at various points in the process to ensure people have the best opportunities possible to consider how direct payments may be of benefit to them. However the person chooses to have their needs met, whether by direct payment, by the provision of local authority-arranged or directly provided care and support, or third-party provision, or a mix of these, there should be no constraint on how the needs are met as long as this is reasonable. The local authority has to satisfy itself that the decision is an appropriate and legal way to meet needs, and should take steps to avoid the decision being made on the assumption that the views of the professional are more valid than those of the person. Above all, the local authority should refrain from any action that could be seen to restrict choice and impede flexibility.

10.48 It is important that people are allowed to be very flexible to choose innovative forms of care and support, from a diverse range of sources, including quality providers but also 'non-service' options such as Information and Communication Technologies ( ICT) equipment, club membership, and massage. Lists of allowable purchases should be avoided as the range of possibilities should be very wide and will be beyond what the local authority is able to list at any point in time. While many authorities may choose to operate lists of quality accredited providers to help people choose (for example some authorities include trading standards-style 'buy with confidence' approaches) the use of such lists should not be mandated as the only choice offer to people. Limited lists of 'prescribed providers' that are only offered to the person on a 'take it or leave it' basis do not fit with the government's vision of personalised care and should be avoided.

Involving the person

10.49 In addition to taking all reasonable steps to agree how needs are to be met, the local authority must also involve the person the plan is intended for, the carer (if there is one), and/or any other person the adult requests to be involved. Where the person lacks capacity to ask the authority to do that, the local authority must involve any person who appears to the authority to be interested in the welfare of the person and should involve any person who would be able to contribute useful information. An independent advocate must be provided if section 67 of the Act applies (see chapter 7). The person, and their carers, will have the best understanding of how the needs identified fit into the person's life as a whole and connect to their overall wellbeing (see chapter 1). They are well placed to consider and identify which care and support options would best fit into their lifestyle and help them to achieve the day to day outcomes they identified during the assessment process. In practice, local authorities should give consideration to include a prompt to the person during the initial stages of the planning process to ask whether there is anyone else that the person wishes to be involved. Where the person lacks capacity, the local authority should make a best interests decision about who else should be involved.

10.50 The level of involvement should be agreed with the individual and any other party they wish to involve and should reflect their needs and preferences. This may entail local authorities involving the person through regular planning meetings, or there may be instances where remote involvement is just as effective, such as over the telephone, through video conferencing, or other means. In other circumstances, local authorities will need to seek the support of speech and language therapists or other specialists such as interpreters. Some people will need little help to be involved, others will need much more. Social workers or other relevant professionals should have a discussion with the person to get a sense of their confidence to take a lead in the process and what support they feel they need to be meaningfully involved.

10.51 The person should be supported to understand what is being discussed and what options are available for them. The local authority should make sure that a person's lack of confidence to take a lead in the process should not limit the extent to which they can play an active role, if they wish to do so. In all cases, people should be allowed to gain support from individuals who they choose to assist their involvement in the planning process. Where they have substantial difficulty in being actively involved in the process, then they should be assisted by a family member or friend. If the person already has an advocate, whose role has been to support the person on matters not under the Care Act, then it may be appropriate for them to support the individual's involvement and represent them. However, if an advocate is required under the Mental Capacity Act 2005 ( MCA) as well as the Care Act, then the instruction, appointment and qualification of the advocate must meet the requirements of the MCA.

10.52 The local authority must instruct an independent advocate if there is no one to represent and support the person's involvement (see chapter 7). This duty arises if the person would, without the representation and support of an independent advocate, experience substantial difficulty in any of the following:

10.53 For example, there may be cases where a person who has substantial difficulty in the above, has no family or friend who can help, and therefore requires an independent advocate to understand the relevant information provided by the local authority, and to be able to use it to effectively plan for their care and support.

10.54 Genuine involvement will aid the development of the plan, increase the likelihood that the options selected will effectively support the adult in achieving the outcomes that matter to them, and may limit disputes as people involved will be fully aware and have agreed to decisions made. Local authorities should ensure that staff have appropriate learning and development opportunities in order to be able to facilitate involvement in the development of the plan.

Authorising others (including the person) to prepare the plan jointly with the local authority

10.55 As stated earlier in this guidance, it is important that local authorities give people every opportunity to prepare their own plan in conjunction with the local authority if they wish.

10.56 Where a plan is being jointly prepared by the local authority and the person whose plan it is, or the local authority and a third party, the local authority should ensure that relevant information is shared securely, promptly and in accordance to the Data Protection Act to allow the plan to be prepared in a timely fashion.

10.57 A partnership approach should be taken, where each partner knows their role and the parties supported to identify options and choose between them. For example, the person may need help to weigh up different service options to understand what each involves and to be able to choose the most appropriate and least restrictive option possible.

10.58 The local authority should also consider cases or circumstances where it may not be appropriate to jointly prepare the plan. For example, a person may not wish their family to be involved, or the authority may be aware that family members may have conflicting interests, or the person may have asked the local authority to prepare the plan with someone who lives far away from the person and even with the assistance of email, phone and other methods of communication is unable to prepare the plan in a timely fashion. The test for allowing the person and others to prepare the plan jointly with the local authority should start with the presumption that the person at the heart of the care plan should give consent for others to do so; and should also have safeguarding principles embedded to ensure that there is no conflict of interest between the person and the third party they wish to involve to prepare the plan jointly with. Where a person lacks capacity and cannot consent to third parties jointly preparing the plan, the local authority must always act in the best interests of the person requiring care and support.

Planning for people who lack capacity

10.59 Good, person-centred care planning is particularly important for people with the most complex needs. Many people receiving care and support have mental impairments, such as dementia or learning disabilities, mental health needs or brain injuries. The principles of the Care Act apply equally to them, in addition to the principles and requirements of the Mental Capacity Act 2005 ( MCA) if the person lacks capacity (see also chapter 7 on independent advocacy).

10.60 The MCA requires local authorities to assume that people have capacity and can make decisions for themselves, unless otherwise established. Every adult has the right to make his or her own decisions in respect of his or her care plan, and must be assumed to have capacity to do so unless it is proved otherwise. This means that local authorities cannot assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability.

10.61 The local authority must support the person to understand and weigh up information, to offer choices and help people to exercise informed choice. A person must be given all practicable help to make the specific decision before being assessed as lacking capacity to make their own decisions.

10.62 Local authorities must understand that people have the right to make what others might regard as an unwise or unusual decision. Everyone has their own values, beliefs and preferences which may not be the same as those of other people. People cannot be treated as lacking capacity for that reason. Sometimes the care and support plan may have unusual aspects; the question to explore is whether it will meet the assessed needs and lead to the desired outcomes.

10.63 If a local authority thinks a person may lack capacity to make a decision or a plan, even after they have offered them all practicable support, a social worker or other suitably qualified professional should carry out a capacity assessment in relation to the specific decision to be made. For example, the local authority may assess whether the person has the capacity to decide whether family members should be involved in their care planning or whether the person has the capacity to decide on whether a particular support option will meet their needs.

10.64 Where an individual has been assessed as lacking capacity to make a particular decision, then the local authority must commence care planning in the person's best interests under the meaning of the MCA. Furthermore a person making a decision concerning a plan on behalf of a person who lacks capacity must consider whether it is possible to make a decision or a plan in a way that would be less restrictive of the person's rights and freedoms of action. Any restriction must be in the person's best interests and necessary to prevent harm to the person, and a proportionate response to the likelihood of the person suffering harm and the seriousness of that harm.

10.65 The duty to involve the person remains throughout the process. If lack of capacity is established, it is still important that the person is involved as far as possible in making decisions. Planning should always be done with the person and not for them; should always start by the identification of their wishes, feelings, values and aspirations, not just their needs, and should always consider their wellbeing in the wider context of their rights to security, to liberty, and to family life.

10.66 Where a person has substantial difficulty in being fully involved in their care planning or lacks capacity to agree and consent to the care plan, they may be supported by family members or friends. If a person has no family or friend who is able to facilitate the person's involvement available and willing to do so, then an independent advocate must be appointed. A friend or family member is not appropriate to facilitate the person's involvement if the person has capacity to decide who they wish to support them and chooses not to be supported by that individual. If the person lacks such capacity, then the local authority must decide on the suitability of the friend or family member to act in the person's best interests. The role of the independent advocate is to:

Minimising and authorising deprivation of liberty (DOL) for people who lack capacity

10.67 In line with the least restrictive principle in the MCA, local authorities and others drawing up plans must minimise planned restrictions and restraints on the person as much as possible. Sections 5 and 6 of the MCA provides legal protection for acts of restraint only if the act is necessary to prevent harm to the person, a proportionate response to the likelihood of the person suffering harm and the seriousness of that harm, and in the person's best interests. Planned restrictions and restraints must be documented and reported to a social worker to agree. Disagreements should be resolved through formal Best Interests meetings, involving a wide range of people, including family members and/or an advocate to support and represent the person.

10.68 However, if the degree and intensity of restrictions and restraints are so significant that they amount to a deprivation of liberty, this must be authorised under the Deprivation of Liberty Safeguards ( DOLS) under the MCA.

10.69 Developing effective person-centred processes for planning in line with the guidance and the Act in general may in most cases avoid circumstances where a deprivation of liberty will arise.

10.70 The difference between a deprivation of liberty and restraint is one of degree, intensity and duration, not necessarily nature or substance. The Supreme Court has clarified that there is a deprivation of liberty for the purposes of Article 5 of the European Convention on Human Rights in the following circumstances: the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to those arrangements. [footnote 38] The precise scope of the term 'deprivation of liberty' is not fixed. It develops over time in accordance with case law.

familiarise themselves with the provisions of the MCA, particularly the 5 principles and specifically the 'least restrictive' principle

when designing and implementing new care and support plans for people lacking capacity, be alert to any restrictions and restraint which may be a degree or intensity that means a person is being, or is likely to be, deprived of their liberty (following the revised test supplied by the Supreme Court)

where a potential deprivation of liberty is identified at the planning or commissioning care stage, a full exploration of the alternative ways of providing the care and/or treatment should be undertaken, in order to identify any less restrictive ways of providing that care which will avoid a deprivation of liberty

where the plan for an individual lacking capacity will unavoidably result in a deprivation of liberty judged to be in the person's best interests, this must be authorised before being implemented

Combining plans

10.73 Local authorities should not develop plans in isolation from other plans (such as plans of carers or family members, or Education, Health and Care plans) and should have regard to all of the person's needs and outcomes when developing a plan, rather than just their care and support needs. [footnote 39]

10.74 The local authority should attempt to establish where other plans are present, or are being conducted and seek to combine plans, if appropriate. This should be considered early on in the planning process (at the same time as considering the person's needs and how they can be met in a holistic way) to ensure that the package of care and support is developed in a way that fits with what support is already being received or developed. For example, this may be where the plan can be combined with a plan being developed to meet other needs, or where a plan might usefully be combined with that of a carer, or family member. In all circumstances, the plan should only be combined if all parties to whom it is relevant agree and understand the implications of sharing data and information. It is the responsibility of the local authority to obtain consent from all parties involved, and the combination of plans should aim to maximize outcomes for all involved.

10.75 Where one of the plans to be combined is for a child (below 18 years old), the child must have capacity to agree to the combination, or if lacking capacity, the local authority must be satisfied that the combination of plans would be in the child's best interests. Often it will be; but where there is a conflict of interest (for example a parent does not wish to support their 17 year old daughter's wish for greater independence) it may not be (see chapter 16 on transition to adult care and support).

10.76 The local authority may be undertaking care and or support planning for 2 people in the same household who require independent advocacy to facilitate their involvement. If both people have the capacity to consent to having the same advocate, and the advocate and the local authority both consider there is no conflict of interest, then the same advocate may support and represent the 2 people. If either person lacks the capacity to consent to having the same advocate, the advocate and local authority must both consider that using the same advocate would not raise a conflict of interest and would be in the best interests of both persons (see chapter 7).

10.77 Consideration should also be given to how plans could be combined where budgets are pooled, either with people in the same household, or between members of a community with similar care needs where this is appropriate and all parties agree (see chapter 11 on personal budgets). Pooling arrangements should not be restricted to individuals using the same provider. Networks of pooling arrangements should be encouraged to bring groups of people together in a more effective manner.

10.78 Where it has been agreed to combine the plan with plans relating to other people, it is important that the individual aspects of each person's plan are not lost in the process of combining plans. The combined plan should reflect the individual needs and circumstance for each person involved, as well as any areas where a joint approach has been agreed to meet needs in a more effective way.

10.79 One key area where plans can be combined cases where the person is receiving both local authority care and support and NHS health care is an example would be a person with mental disorder who meets the criteria for care and support under the multi-agency Care Programme Approach. The introduction of personal health budgets in health, similar to personal budgets in social care, provides a powerful tool to enable integrated health and care provision which focuses on what matters most to the person. Local authorities should provide information to the person of the benefits of combining health and social care support, and seek to work with health colleagues to combine health and care plans wherever possible.

10.80 In combining plans, whether among people or organisations (such as health, education or housing), it is vital to avoid duplicating process or introducing multiple monitoring regimes. Information sharing should be rapid and seek to minimise bureaucracy. Local authorities should work alongside health and other professionals (such as housing) where plans are combined to establish a 'lead' organisation who undertakes monitoring and assurance of the combined plan (this may also involve appointing a lead professional and detailing this in the plan so the person knows who to contact when plans are combined). Particular consideration should be given to ensuring that processes are aligned, coherent and streamlined, to avoid confusing the person with different systems (see Chapter 14 on integration and cooperation).

Sign-off and assurance

10.81 The local authority must take all reasonable steps to agree with the person the manner in which the plan details how needs will be met, before the authority signs off the plan. Therefore, it should not introduce measures that place any undue burden on the person, especially where the person or third party is preparing the plan in conjunction with the local authority. The local authority should therefore avoid developing processes that undermine the joint preparation of plans, such as excessive quality control. For example, a local authority may have arrangements or contract with outside organisations/individuals to provide peer support for planning. If so, an important part of this contract should be around having agreement as to non-restrictive approaches that enhance the quality of plans and the local authority's trust in the detail as well as removing issues that can cause delay and problems.

10.82 The local authority's role where the person or third-party are undertaking the preparation of the plan jointly with the local authority includes overseeing and providing guidance for the completion of the plan; and ensuring that the plan sufficiently meets needs, is appropriate and represents the best balance between value for money and maximisation of outcomes for the person. For example, this may involve providing materials and approaches to support people jointly preparing the plan with the local authority. Where the local authority is preparing the plan on behalf of the person, or delegating this to a third-party to do so, the best interests of the person must be reflected throughout.

10.83 The local authority must take all reasonable steps to reach agreement with the person for whom the plan is being prepared. Wherever possible, local authority sign-off should occur when the person, any third party involved in the preparation of the plan and the local authority have agreed on the factors within the plan, including the final personal budget amount (which may have been subject to change during the planning process), and how the needs in question will be met. This is a key part of the planning process and the agreement should be recorded and a copy placed within the plan. Where an independent advocate has been involved, they should not be asked to sign off the plan - this is the responsibility of the local authority.

10.84 While there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion, proportionate to the needs to be met. Local authorities must ensure that sufficient time is taken to ensure the plan is appropriate to meet the needs in question, and is agreed by the person the plan is intended for. The planning process should not unduly delay needs being met.

10.85 Due regard should be taken to the use of approval panels in both the timeliness and bureaucracy of the planning and sign-off process. In some cases, panels may be an appropriate governance mechanism to sign-off large or unique personal budget allocations and/or plans. Where used, panels should be appropriately skilled and trained, and local authorities should refrain from creating or using panels that seek to amend planning decisions, micro-manage the planning process or are in place purely for financial reasons. Local authorities should consider how to delegate responsibility to their staff to ensure sign-off takes place at the most appropriate level. In cases or circumstances where a panel is to be used, and where an expert assessor has been involved in the care and support journey, the same person or another person with similar expertise should be part of the panel to ensure decisions take into account complex or specialist issues.

10.86 In the event that the plan cannot be agreed with the person, or any other person involved, the local authority should state the reasons for this and the steps which must be taken to ensure that the plan is signed-off. This may require going back to earlier elements of the planning process. People must not be left without support while a dispute is resolved. If a dispute still remains, and the local authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure. However, by conducting person-centred planning and ensuring genuine involvement throughout, this situation should be avoided.

10.87 Upon completion of the plan, the local authority must give a copy of the final plan which should be in a format that is accessible to the person for whom the plan is intended, any other person they request to receive a copy, and their independent advocate if they have one and the person agrees. This should not restrict local authorities from making the draft plan available throughout the planning process; indeed in cases where a person is preparing the plan in conjunction with the local authority, the plan should be in their possession. Consideration should also be given to sharing key points of the final plan with other professionals and supporters, with the person's consent (for example, as part of the person's health record), or sharing the plan in the best interests of a person who lacks capacity to decide on this matter.

Protecting property of adults being cared for away from home

10.88 Local authorities must take all reasonable steps to protect the moveable property of an adult with care and support needs who is being cared for away from home, in a hospital or in accommodation such as a care home, and who cannot arrange to protect their property themselves; this could include their pets as well as their personal property (for example, private possessions and furniture). Local authorities must act where it believes that if it does not take action there is a risk of moveable property being lost or damaged.

10.89 For example, protecting property may include arranging for pets to be looked after when securing premises for someone who is having their care and support needs provided away from home in a care home or hospital, and who has not been able to make other arrangements for the care of their home or pets.

10.90 In order to protect moveable property in these circumstances the local authority may enter the property, at reasonable times, with the adult's consent; but reasonable prior notice to enter should be given. If the adult lacks the capacity to give consent to the local authority entering the property, consent should be sought from a person authorised under the Mental Capacity Act 2005 to give consent on the adult's behalf. This might be:

10.91 If the adult in question lacks capacity and no other person has been authorised to act on their behalf, then the local authority must act in the best interests of the adult in accordance with section 4 of the Mental Capacity Act 2005.

10.92 If a third party tries to stop an authorised entry into the home then they will be committing an offence, unless they can give a good reason for why they are obstructing the local authority in protecting the adult's property. Committing such an offence could, on conviction by a Magistrates' Court, lead to the person being fined up to a maximum fine not exceeding level 4 on the standard scale. If a local authority intends to enter a home then it must give written authorisation to an officer of the council and that person must be able to produce it if asked for.

10.93 The local authority has no power to apply for a warrant to carry out their duties to protect property. The enforcement power is prosecution for unreasonable obstruction. However, if the Court decides the obstruction is reasonable then the local authority would have no further power to force entry.

10.94 This duty on the local authority lasts until the adult in question returns home or makes their own arrangements for the protection of property or until there is no other danger of loss or damage to property; whichever happens first. Often a one off event is required such as the re-homing of pets or ensuring that the property is secured. However, if costs are incurred or if there are ongoing costs the local authority can recover any reasonable expenses they incur in protecting property under this duty from the adult whose property they are protecting.

11. Personal budgets

This chapter provides guidance on Section 26 of the Care Act 2014 and the Care and Support (Personal Budget Exclusion of Costs) Regulations 2014, including:

11.1 Personal budgets are a key part of the government's aspirations for a person-centred care and support system. Independent research shows that where implemented well, personal budgets can improve outcomes and deliver better value for money. [footnote 40] [footnote 41] [footnote 42] [footnote 43]

11.2 The Act places personal budgets into law for the first time, making them the norm for people with care and support needs.

11.3 The personal budget is the mechanism that, in conjunction with the care and support plan, or support plan, enables the person, and their advocate if they have one, to exercise greater choice and take control over how their care and support needs are met. It means:

11.4 It is vital that the process used to establish the personal budget is transparent so that people are clear how their budget was calculated, and the method used is robust so that people have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs. The allocation of a clear upfront indicative (or 'ball-park') allocation at the start of the planning process will help people to develop the plan and make appropriate choices over how their needs are met.

11.5 The process of allocating the personal budget should be completed in a timely manner, proportionate to the needs to be met. At all times the person should be informed where they are in the care planning process, what will happen next and the likely timeframes.

11.6 This chapter applies to people in need of care and support and carers equally, unless specifically stated.

The personal budget

11.7 Everyone whose needs are met by the local authority, whether those needs are eligible, or if the authority has chosen to meet other needs, must receive a personal budget as part of the care and support plan, or support plan. The personal budget is an important tool that gives the person clear information regarding the money that has been allocated to meet the needs identified in the assessment and recorded in the plan. An indicative amount should be shared with the person, and anybody else involved, at the start of care and support planning, with the final amount of the personal budget confirmed through this process. The detail of how the personal budget will be used is set out in the care and support plan, or support plan. At all times, the wishes of the person must be considered and respected. For example, the personal budget should not assume that people are forced to accept specific care options, such as moving into care homes, against their will because this is perceived to be the cheapest option.

11.8 This allows the person, and anybody else the person wishes, to make informed decisions about how to meet their care and support needs. The person can choose for the personal budget allocation to remain with the local authority to arrange care and support on the person's behalf, and in line with their wishes. Alternatively, if available locally, it can be placed with a third-party provider on the same basis, often called an individual service fund ( ISF). Where an ISF-type arrangement is not available locally, the local authority should explore arrangements to develop this offer, and should be receptive to requests from personal budget recipients to create these arrangements with specified providers.

11.9 There may also be cases where a person prefers to use a mixed package of care and support. For example, this may be a direct payment to the person for some of their needs, with the remainder of the personal budget used to meet needs via local authority or third-party provision, or any combination of the above. The method of allocating the personal budget should be decided and agreed during the care and support planning process (see chapter 10). It is important that these arrangements can be subsequently adjusted if the person wishes this, with the minimum of procedure. The process for allocating and agreeing the personal budget via the planning process should be as straightforward and as timely as possible so that the person can access the budget without significant delay.

Elements of the personal budget

11.10 The personal budget must always be an amount sufficient to meet the person's care and support needs, and must include the cost to the local authority of meeting the person's needs which the local authority is under a duty to meet, or has exercised its power to do so. This overall cost must then be broken down into the amount the person must pay, following the financial assessment, and the remainder of the budget that the authority will pay.

11.11 The personal budget may also set out other amounts of public money that the person is receiving, such as money provided through a personal health budget. Local authorities should consider requests from individuals to present their personal budget in this way. Integrated health and care, and integration of other aspects of public support are the long-term vision of the government. This will provide the individual with a seamless experience, and can help to remove unnecessary bureaucracy and duplication that may exist where a person's needs are met through money from multiple funding streams.

11.12 Local authorities must carry out their care and support responsibilities with a view to promoting integration with health and other related services (such as housing), and therefore should take a lead in driving the integration of support services for their population. For example, this may involve agreeing with partner organisations how to integrate budgets and to what extent, and the establishment of a lead organisation that agrees to oversee monitoring and assurance of all budgets the person is receiving.

11.13 Where a local authority is meeting the eligible needs of a person whose financial resources are above the financial limit, but who has requested the local authority meet their needs, the local authority may make a charge for putting in place the necessary arrangements to meet needs (see chapter 8 on charging and financial assessment). Where this occurs, the local authority should consider how best to set this information out to the person, in a format accessible to them. This fee is not part of the personal budget, since it does not relate directly to meeting needs, but it may be presented alongside the budget to help the person understand the total charges to be paid. For example, a local authority may wish to specify this in both the plan and the personal budget for the person so all parties are clear on how costs are allocated.

11.14 Similarly, there will be cases where a person or a third party on their behalf is making an additional payment (or a 'top-up') in order to be able to secure the care and support of their choice, where this costs more than the local authority would pay for such a type of care. In these cases, the additional payment does not form part of the personal budget, since the budget must reflect the costs to the local authority of meeting the needs. However, the local authority should consider how best to present this information to the individual, so that the total amount of charges paid is clear, and the link to the personal budget amount is understood.

Elements of care and support that are excluded from the personal budget

11.15 Regulations set out the cases or circumstances where the costs of meeting the needs of care and support do not have to be incorporated into the personal budget. Because both the care and support plan and personal budget are mechanisms to enable people to have greater choice and control over their care and support, there are not many instances where this exclusion will apply.

11.16 The Care and Support (Personal Budget Exclusion of Costs) Regulations 2014 set out that the provision of intermediate care and reablement services, for which the local authority cannot or chooses not to make a charge [footnote 44] must be excluded from the personal budget. This will mean that where either intermediate care or reablement is being provided to meet needs (for example, under section 18, 19 or 20 of the Act) the cost of this must not be included in the personal budget.

11.17 Intermediate care services are usually provided to patients, often older people, after leaving hospital or when they are at risk of being sent to hospital. The services are a link between places such as hospitals and people's homes, and between different areas of the health and social care system - community services, hospitals, GPs and social care. 'Reablement' is a particular type of intermediate care, which has a stronger focus on helping the person to regain skills and capabilities to reduce their needs, in particular through the use of therapy or minor adaptations. There is a tendency for the terms 'reablement', 'rehabilitation' and 'intermediate care' to be used interchangeably. The National Audit of Intermediate Care categorises 4 types of intermediate care: crisis response - services providing short-term care (up to 48 hours); home-based intermediate care - services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists; bed-based intermediate care - services delivered away from home, for example, in a community hospital; and reablement - services to help people live independently, provided in the person's own home by a team of mainly social care professionals (see chapter 2 - preventing, reducing or delaying needs).

11.18 Three of the 4 types of intermediate care have historically been clinician-led and provided by health staff, with reablement being provided by local authorities. However, these are not concrete, mutually-exclusive categories - and, furthermore, with greater integration and co-operation between health and local authorities, there should be greater use of qualified staff from health and social care working together to provide intermediate care.

11.19 Local authorities should not include additional elements that would not normally be classified as intermediate care or reablement into this exclusion. Indeed, the Act restricts the regulations into specifying only care and support which the local authority cannot charge for, or chooses not to charge for. This ensures that long-term care and support will always be part of the personal budget, and in future, count towards the cap on care costs. Also, broader rehabilitation services could be included to an individual to meet identified health needs as part of a joint personal budget across health and social care.

11.20 Intermediate care/reablement should usually be provided as a free, universal service under section 2 of the Act, and therefore would not contribute to the personal budget amount. However, in some circumstances, a local authority may choose to combine either service with aspects of care and support to meet eligible or ongoing needs, which would require a personal budget to be developed. Removing the cost of provision of intermediate care/reablement from the personal budget in these scenarios ensures that the allocation of both services is applied uniformly across all local authorities, and in future people progress towards the cap on care costs in a fair and consistent way.

11.21 In cases where intermediate care/ reablement is provided to meet needs under section 18 or 20(1) or under section 19(1) or 20(6), either in isolation or combined with longer-term care and support, the plan should describe what the package consists of and how long it will last. This will help the person understand what is being provided to meet their needs. However, the person should not receive a personal budget, unless there are other forms of care and support being provided under these sections. In these cases, the personal budget amount must not include the cost of intermediate care/reablement which are provided free of charge.

Calculating the personal budget

11.22 It is important to have a consistent method for calculating personal budgets that provides an early indication of the appropriate amount to meet the identified needs to be used at the beginning of the planning process. Local authorities should ensure that the method used for calculating the personal budget produces equitable outcomes to ensure fairness in care and support packages regardless of the environment in which care and support takes place, for example, in a care home or someone's own home. Local authorities should not have arbitrary ceilings to personal budgets that result in people being forced to accept to move into care homes against their will.

11.24 Regardless of the process used, the most important principles in setting the personal budget are transparency, timeliness and sufficiency. This will ensure that the person, their carer, and their independent advocate if they have one, is fully aware of how their budget was calculated, that they know the amount at a stage which enables them to effectively engage in care and support planning, and that they can have confidence that the amount includes all relevant costs that will be sufficient to meet their identified needs in the way set out in the plan. The local authority should also explain that the initial indicative allowance can be increased or decreased depending on the decisions made during the development of the plan. This should prevent disputes from arising, but it must also be possible for the person, carer or independent advocate (on the person's behalf) to challenge the local authority on the sufficiency of the final amount. These principles apply to both the indicative upfront budget and the final signed=off personal budget that forms part of the care and support plan.

Transparency

Authorities should make their allocation processes publicly available as part of their general information offer, or ideally provide this on a bespoke basis for each person the authority is supporting in a format accessible to them. This will ensure that people fully understand how the personal budget has been calculated, both in the indicative amount and the final personal budget allocation. Where a complex RAS process is used, local authorities should pay particular consideration to how they will meet this transparency principle, to ensure people are clear how the personal budget was derived.

Timeliness

It is crucial when calculating the personal budget to arrive at an upfront allocation which can be used to inform the start of the care and support planning process. This 'indicative budget' will enable the person to plan how the needs are met. After refinement during the planning process, this indicative amount is then adjusted to be the amount that is sufficient to meet the needs which the local authority is required to meet under section 18 or 20(1), or decides to meet under section 19(1) or (2) or 20(6). This adjusted amount then forms the personal budget recorded in the care plan.

Sufficiency

The amount that the local authority calculates as the personal budget must be sufficient to meet the person's needs which the local authority is required to meet under section 18 or 20(1), or decides to meet under section 19(1) or (2) or 20(6) and must also take into account the reasonable preferences to meet needs as detailed in the care and support plan, or support plan.

11.25 The Act states the personal budget must be an amount that is the cost to the local authority of meeting the person's needs. In establishing the 'cost to the local authority', consideration should therefore be given to local market intelligence and costs of local quality provision to ensure that the personal budget reflects local market conditions and that appropriate care that meets needs can be obtained for the amount specified in the budget. To further aid the transparency principle, these cost assumptions should be shared with the person so they are aware of how their personal budget was established. Consideration should also be given as to whether the personal budget is sufficient where needs will be met via direct payments, especially around any other costs that may be required to meet needs or ensure people are complying with legal requirements associated with becoming an employer (see chapter 12). There may be concern that the 'cost to the local authority' results in the direct payment being a lesser amount than is required to purchase care and support from the local market due to local authority bulk purchasing and block contract arrangements. However, by basing the personal budget on the cost of quality local provision, this concern should be allayed.

11.26 However, a request for needs to be met via a direct payment does not mean that there is no limit on the amount attributed to the personal budget. There may be cases where it is more appropriate to meet needs via directly-provided care and support, rather than by making a direct payment. For example, where there is no local market for a particular kind of care and support that the person wishes to use the direct payment for, except for services provided by the local authority. It may also be the case where the costs of an alternate provider arranged via a direct payment would be more than the for what the local authority would be able to arrange the same support, whilst achieving the same outcomes for the individual.

11.27 In all circumstances, consideration should be given to the expected outcomes of each potential delivery route. It may be that by raising the personal budget to allow a direct payment from a particular provider, it is expected to deliver much better outcomes than local authority delivered care and support, or there may be other dynamics such as the preferred option reducing the need for travel costs, or out of hours care. In addition, efficiencies to the local authority (for example through an individual making their own arrangements) should also be considered. Decisions should therefore be based on outcomes and value for money, rather than purely financially motivated.

11.28 In cases where making a direct payment is a more expensive option to meet needs, the care plan should be reviewed to ensure that it is accurate and that the personal budget allocation is correct. The authority should work with the person, their carer and independent advocate (if there is one) to agree on how best to meet their care and support needs. It may be that the person can take a mixture of direct payment and local authority-arranged care and support, or the local authority can work with the person to discuss alternate uses for the personal budget. Essentially, these discussions will take place during the planning process and local authorities should ensure that their staff are appropriately trained to support personalised care and support, and to facilitate decision-making.

Example: Costs of direct payments 1

Andrew has chosen to meet his needs by receiving care and support from a PA. The local authority has a block contract with an agency which has been providing support to Andrew twice per week. Andrew would now like more flexibility in the times at which he receives support in order to better meet his needs by allowing him to undertake other activities and consider employment.

He therefore requests a direct payment so that he can make his own arrangements with another agency, which is happy to arrange a much more flexible and personalised service, providing Andrew with the same care worker on each occasion, and at a time that works best for him.

The cost to the local authority of the block contracted services is £13.50 per hour. However, the more flexible support costs £18 per hour (inclusive of other employment costs). The local authority therefore increases Andrew's direct payment from £67.50 to £90 per week to allow him to continue to receive the care he requires. The solution through a direct payment delivers better outcomes for Andrew and therefore the additional cost is reasonable and seen as value for money as it may delay future needs developing.

The local authority also agrees it is more efficient for them to allow Andrew to arrange and commission the hours he wants to receive support and handle the invoicing himself.

Example: Costs of direct payments 2

Following George's assessment of needs, the local authority work out an indicative personal budget of £135 per week, based on their block contract rate of £13.50 per hour as an indication of the potential costs to meet his needs.

During care planning, George states that he has a neighbour that has recently trained to become a personal assistant, and George indicates a preference to use a direct payment to employ the neighbour instead of an arranged service.

The local authority is satisfied that George will be able to manage the direct payment, and that he understands his responsibilities as an employer. George wants to pay the PA above the living wage and has provisionally agreed a hourly rate of £9 per hour.

The local authority agrees to this as George agrees that it will meet his needs and outcomes. The final personal budget is adjusted to £110 per week which factors in the new hourly rate, plus an additional allowance for employment responsibilities (PAYE, NI, insurance)

Use of the personal budget

11.29 The person should have the maximum possible range of options for managing the personal budget, including how it is spent and how it is utilised. Directing spend is as important for those choosing the council-managed option or individual service fund as for those choosing direct payments. Evidence suggests that people using council-managed personal budgets are currently not achieving the same level of outcomes as those using direct payments, and in too many cases do not even know they have been allocated a personal budget.

11.30 There are 3 main ways in which a personal budget can be deployed:

as a managed account held by the local authority with support provided in line with the persons wishes

as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the persons wishes [footnote 45]

as a direct payment

11.31 In addition, a person may choose a 'mixed package' that includes elements of some or all 3 of the approaches above. Local authorities must ensure that whatever way the personal budget is used, the decision is recorded in the plan and the person is given as much flexibility and choice as is reasonably practicable in how their needs are met. The mixed package approach can be a useful option for people who are moving to direct payments for the first time. This allows a phased introduction of the direct payment, giving the person time to adapt to the direct payment arrangements.

11.33 Where there are no ISF arrangements available locally, the local authority should consider establishing this as an offer for people. Additionally, the local authority should reasonably consider any request from a person for an ISF arrangement with a specified provider.

Examples: Using individual service funds

Sally really enjoys dancing and night clubs and she needs support for this. Sally's ISF arrangement with her provider has given her the flexibility to employ staff that also like to do this, and they are paid time and a half after 11:00pm. The ISF arrangement also allows Sally to convert 'standard hours' into 'enhanced hours', for example, 6 standard hours equals 4 enhanced hours. Sally can plan late nights out knowing what it 'costs' from her allocation of 24 standard hours support, which is calculated from her personal budget.

Brian's ISF arrangement with his provider allows him to save up and then convert the hours of his support into money to purchase personal trainer time at a local gym. In addition to promoting wellbeing in the areas of emotional and social wellbeing and personal relationships, these arrangements also demonstrate the local authority's regard for the importance of beginning with the assumption that an individual is best-placed to judge their own wellbeing.

11.34 Local authorities should also give consideration to how choice could be increased by people pooling their budgets together. For example, this may include pooling budgets of people living in the same household such as an adult and carer, or pooling budgets of people within a community with similar care and support needs, or aspirations. Pooling budgets in circumstances such as this may deliver increased choice, especially where managed budgets are concerned. Developing networks of 'budget poolers' could help create dynamic groups of people working together to meet needs.

11.35 Evidence suggests that in most cases people need to know the amount of their budget, be able to choose how it is managed, and have maximum flexibility in how it is used to achieve the best outcomes. Therefore the process and practice for personal budgets should follow the key principles of self-directed support. Local authorities should aim to develop a range of means to enable anyone to make good use of direct payments and where people choose other options, should ensure local practice that maximises choice and control (for example use of Individual Service Funds). Local authorities should also take care not to inadvertently limit options and choices. For example 'pre-paid cards' can be a good option for some people using direct payments, but must not be used to constrain choice or be only available for use with a restricted list of providers.

Use of a carer's personal budget

11.36 Specific consideration should be given to how a personal budget will be used by carers. The Act specifies that a carer's need for support can be met by providing care to the person they care for. However, decisions on for whom a particular service is to be provided may affect issues such as whether the service is chargeable, and who is liable to pay any charges. It is therefore important that it is clear to all individuals involved whose needs are intended to be met by a particular type of support, to whom the support will be provided directly, and therefore who may pay any charges due. Where a service is provided directly to the adult needing care, even though it is to meet the carer's needs, then that adult would be liable to pay any charge, and must agree to doing so. Section 14 of the Act makes clear that where the needs are met by providing care and support direct to the adult needing care, the charge may not be imposed on the carer.

11.37 Decisions on which services are provided to meet carers' needs, and which are provided to meet the needs of the adult for whom they care, will therefore impact on which individual's personal budget includes the costs of meeting those needs. Local authorities should make this decision as part of the care planning process, in discussion with the individuals concerned, and should consider whether joint plans (and therefore joint personal budgets) for the 2 individuals may be of benefit.

11.38 Local authorities should consider how to align personal budgets where they are meeting the needs of both the carer and the adult needing care concurrently. Where an adult has eligible needs for care and support, and has a personal budget and care and support plan in their own right, and the carer's needs can be met, in part or in full, by the provision of care and support to that person needing care, then this kind of provision should be incorporated into the plan and personal budget of the person with care needs, as well as being detailed in a care and support plan for the carer.

Examples: Flexible use of a carer's personal budget

Conor has been caring for his wife, who is in a wheelchair with ME and arthritis, for the last 9 years. He does all the cooking, driving and general household duties for their household. Conor received a personal budget which he requested in the form of a direct payment from his local authority for a laptop to enable him to be in more regular contact through Skype with family in the US. This now enables Conor to stay connected with family he cannot afford to fly and see. This family support helps Connor with his ongoing caring role.

Divya has 4 young children and provides care for her father who is nearing the end of his life. Her father receives a direct payment, which he used to pay a family member for a period of time to give his daughter a break from her caring role. Divya received a carers' direct payment, which she uses for her children to attend summer play schemes so that she get some free time to meet with friends and socialise when the family member providers care to her father. This gives Divya regular breaks from caring which are important to the family unit.

11.39 'Replacement care' may be needed to enable a carer to look after their own health and wellbeing alongside caring responsibilities, and to take a break from caring. For example, this may enable them to attend their own health appointments, or go shopping and pursue other recreational activities. It might be that regular replacement care overnight is needed so that the carer can catch up on their own sleep. In other circumstances, longer periods of replacement care may be needed, for example to enable carers to have a longer break from caring responsibilities or to balance caring with education or paid employment. In these circumstances, where the form of the replacement care is essentially a homecare service provided to the adult needing care that enables the carer to take a break, it should be considered a service provided to the cared-for person, and thus must be charged to them, not the carer.

11.40 The carer's personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role, and takes into account the outcomes that the carer wishes to achieve in their day to day life. This includes their wishes and/or aspirations concerning paid employment, education, training or recreation if the provision of support can contribute to the achievement of those outcomes. The manner in which the personal budget will be used to meet the carer's needs should be agreed as part of the planning process.

11.41 Local authorities must have regard to the wellbeing principle of the Act, as it may be the case that the carer needs a break from caring responsibilities to look after their own physical/mental health and emotional wellbeing, social and economic wellbeing and to spend time with other members of the family and personal relationships. Whether or not there is a need for replacement care, carers may need support to help them to look after their own wellbeing. This may be, for example, a course of relaxation classes, training on stress management, gym or leisure centre membership, adult learning, development of new work skills or refreshing existing skills (so they might be able to stay in paid employment alongside caring or take up return to paid work), pursuit of hobbies such as the purchase of a garden shed, or purchase of a laptop so they can stay in touch with family and friends.

Carers' personal budgets where the adult being cared for does not have eligible needs

11.42 The Act makes clear that the local authority is able to meet the carer's needs by providing a service directly to the adult needing care. However, there may be instances where the adult being cared for does not have eligible needs, so does not have their own personal budget or care plan. In these cases, the carer must still receive a support plan which covers their needs, and how they will be met. This would specify how the carer's needs are going to be met (for example, via replacement care to the adult needing care), and the personal budget would be for the costs of meeting the carer's needs.

11.43 The adult needing care would not receive a personal budget or care plan, because no matter what the service is in practice, it is designed to meet the carer's needs. However, it is essential that the person requiring care is involved in the decision-making process and agrees with the intended course of action.

11.44 In situations such as these, the carer could request a direct payment, and use that to commission their own replacement care from an agency, rather than using an arranged service from the local authority or a third party. The local authority should take steps to ensure that the wishes of the adult requiring care are taken into account during these decisions. For example, the adult requiring care may not want to receive replacement care in this manner.

11.45 If such a type of replacement care is charged for (and it may not be), then it would be the adult needing care that would pay, not the carer, because they are the direct recipient of the service. This is in part why it is so important that the adult needing care agrees to receiving that type of care. The decisions taken by the carer and adult requiring care and charging implications should be agreed and recorded in the support plan. If a dispute arises and the person refused to pay the charge, the local authority must, as far as it is feasible, identify some other way of supporting the carer.

11.46 For the purposes of charging, the personal budget which the carer receives must specify the costs to the local authority and the costs to the adult, based on the charging guidance (see chapter 8). In this case, 'the adult' refers to the carer, because they are the adult whose needs are being met. However, in instances where replacement care is being provided, the carer should not be charged; if charges are due to be paid then these have to be met by the adult needing care. Any such charges would not be recorded in the personal budget, but should be set out clearly and agreed by those concerned.

Disputes

11.47 The local authority should take all reasonable steps to limit disputes regarding the personal budget allocation. This will include through effective care and support planning, and transparency in the personal budget allocation process. Additionally, many disputes may be avoided by informing people of the timescales that are likely to be involved in different stages of the process. Keeping people informed how their case is progressing may help limit the number of disputes.

11.48 Current complaints provision for care and support is set out in regulations. [footnote 46] The provisions of the regulations mean that anyone who is dissatisfied with a decision made by the local authority can make a complaint about that decision and have that complaint handled by the local authority. The local authority must make its own arrangements for dealing with complaints in accordance with the 2009 regulations.

12. Direct payments

This chapter covers:

making direct payments available

considerations for adults with and without capacity

administering, monitoring and reviewing direct payments

using the direct payment

paying family members

short-term and long-term care in a care home

becoming an employer

direct payments and hospital stays

direct payments for local authority services

direct payments in the form of pre-payment cards

harmonisation of direct payments

terminating direct payments

12.1 Direct payments are monetary payments made to individuals who request to receive one to meet some or all of their eligible care and support needs. The legislative context for direct payments is set out in the Care Act, Section 117(2C) of the Mental Health Act 1983 (the 1983 Act) and the Care and Support (Direct Payments) Regulations 2014.

12.2 Direct payments have been in use in adult care and support since the mid-1990s and they remain the Government's preferred mechanism for personalised care and support. They provide independence, choice and control by enabling people to commission their own care and support in order to meet their eligible needs. [footnote 47]

12.3 Direct payments, along with personal budgets and personalised care planning, mandated for the first time in the Care Act, provide the platform with which to deliver a modern care and support system. People should be encouraged to take ownership of their care planning, and be free to choose how their needs are met, whether through local authority or third-party provision, by direct payments, or a combination of the 3 approaches.

12.4 For direct payments to have the maximum impact, the processes involved in administering and monitoring the payment should incorporate the minimal elements to allow the local authority to fulfil its statutory responsibilities. These processes must not restrict choice or stifle innovation by requiring that the adult's needs are met by a particular provider, and must not place undue burdens on people to provide information to the local authority. An effective monitoring process should also go beyond financial monitoring, and include aspects such as identifying wider risks and issues, for example non-payment of tax, and provision of employers' liability insurance where this is appropriate.

12.5 The local authority also has a key role in ensuring that people are given relevant and timely information about direct payments, so that they can make a decision whether to request a payment, and, if doing so, are supported to use and manage the payment appropriately. The route to a direct payment is for a person to request one, but the local authority should support the person's right to make this request by providing information and advice as detailed above. People must not be forced to take a direct payment against their will, but instead be informed of the choices available to them.

12.6 This chapter should be read in conjunction with the sections on care and support planning and personal budgets (see chapters 10 and 11), and applies to people in need of care and support and carers equally, unless specifically stated.

Making direct payments available

12.7 The availability of direct payments should be included in the universal information service that all local authorities are required to provide. This should set out:

what direct payments are

how to request one including the use of nominated and authorised persons to manage the payment

explanation of the direct payment agreement and how the local authority will monitor the use of the direct payment

the responsibilities involved in managing a direct payment and being an employer;

making arrangements with social care providers

signposting to local organisations (such as user-led organisations and micro-enterprises) and the local authority's own internal support, who offer support to direct payment holders, and information on local providers

case studies and evidence on how direct payments can be used locally to innovatively meet needs [footnote 48]

12.8 This will allow people to be fully aware what direct payments are and whether they are something that are of interest. In addition to this general information, authorities must also explain to people what needs could be met by direct payments during the care and support planning process.

12.9 Local authorities have a crucial role to play in promoting the use of direct payments, and enabling people to make requests to receive direct payments in an efficient way. However, the gateway to receiving a direct payment must always be through the request from the person. Local authorities must not force people to take a direct payment against their will, or allow people to be placed in a situation where the direct payment is the only way to receive personalised care and support. However, local authorities are encouraged to prompt people to consider direct payments and how they could be used to meet needs.

Steps following a request to receive direct payments

12.10 It is expected that most requests to receive direct payments will occur during the care planning stage as this is when authorities must inform the person of the needs that could be met via direct payments. However, local authorities must consider requests for direct payments made at any time, and have clear and swift processes in place to respond to the requests. For example, a person may request a direct payment before a scheduled or anticipated review. In these cases, the local authority must assess the request on the same basis as a request made during care planning. In practice, it may be convenient to consider the request at the same time as a review of the care plan. In these cases, the review should be brought forward so as not to delay the consideration of the direct payment request (see chapter 13 on reviews). The steps to follow after receiving a request for a direct payment will depend on whether the person has been assessed as having capacity to make a decision about direct payments or not, which should have taken place at the assessment of needs (see chapter 6).

Assessing capacity

The following considerations should be made when assessing capacity:

12.11 Mental capacity is the ability to make a decision. Under the 2005 Mental Capacity Act, a person lacks capacity in relation to a matter if, at the material time, they are unable to make a decision in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.

12.12 Assessments of capacity must always be made on a case-by-case basis, in relation to the specific decision to be made. Assumptions should not be made due to the existence of a particular condition, nor on whole groups of people.

12.13 Consideration should also be given to whether capacity is constant or likely to fluctuate. Where it is clear that fluctuating capacity is a known issue, or likely to be, this should be covered in the care plan which details the steps to take where capacity fluctuates. The Care and Support (Direct Payments) Regulations 2014 allow for direct payments to continue to be made in cases of fluctuating capacity (see paras. 12.67-12.68 on terminating direct payments).

Adults with capacity

12.14 Where the local authority is satisfied that the person has capacity to make a request for direct payments to cover some or all of their care needs, it must consider each of the 4 conditions in section 31 of the Care Act. These conditions need to be met in their entirety; a failure in one would result in the request to receive a direct payment being declined. The conditions are:

12.15 The authority must clarify at the earliest stage possible where the request originates from. The Care Act provides a power to enable direct payments to be made to the person in need of care and support, or a nominated person acting on their behalf if the adult so requests. Where a nominated person has been requested to receive the direct payment, the authority should involve the nominated person in any appropriate stages of the care planning journey, such as the development of the care plan, as long as the person with care needs agrees to this. Where the person does not specifically request this involvement, the local authority should consider whether to encourage the person to make that request. During this process, the nominated person should receive information regarding the local authorities direct payments processes, as well as information and advice on using and managing the direct payment, so that the nominated person understands their legal obligations as the direct payment recipient to act in the best interests of the person requiring care and support (see paras. 12.48-12.51 on becoming an employer). The local authority must also satisfy itself that the nominated person meets the conditions in Section 31 of the Act.

Adults lacking capacity

12.16 In cases where the person in need of care and support has been assessed as lacking capacity to request the direct payment, an authorised person can request the direct payment on the person's behalf. In these cases, the local authority must satisfy itself that the person meets the 5 conditions as set out in section 32 of the Care Act.

12.17 As with direct payments for people with capacity, each of these conditions must be met in their entirety. Failure to meet any of the conditions would result in the request being declined. The conditions are:

Consideration of the request

12.18 After considering the suitability of the person requesting the direct payment against the appropriate conditions in the Care Act, the local authority must make a determination whether to provide a direct payment. Where accepted, the decision should be recorded in the care plan, or support plan. Where refused, the person or person making the request should be provided with written reasons that explain the decision, and be made aware of how to appeal the decision through the local complaints process.

12.19 The Care Act defines one of the conditions to be met is that the direct payment is an appropriate way to meet the needs in question (or, in respect of after-care services, an appropriate way to discharge its duty under section 117 of the 1983 Act). [footnote 49] Local authorities must not use this condition to arbitrarily decline a request for a direct payment. For example, there may be instances where a person is obliged to receive services as a condition of mental health legislation (including a community treatment order, guardianship or leave of absence from hospital under the Mental Health Act or provisions in other mental health legislation). In these cases, although the person is being obliged to receive services rather than choosing to present for services, it may still be appropriate to give the person the responsibility of meeting their needs via a direct payment, if this is what is requested. Particular consideration should be given to these cases when applying the conditions set out in the Act. In all cases, appropriateness is for local authorities to determine, although it is expected that in general, direct payments are an appropriate way to meet most care and support needs.

12.20 However, there may be cases where a direct payment is not appropriate to meet needs. The Regulations set out that direct payments cannot be made to people subject to a court order for a drug or alcohol treatment program or similar schemes (schedule 1 of the Regulations).

12.21 A further condition is that the local authority must be satisfied that the person is able to manage the direct payment by him or herself, or with whatever help or support the person will be able to access. Local authorities should therefore take all reasonable steps to provide this support to whoever may require it. To comply with this, many local authorities have contracts with voluntary or user-led organisations that provide support and advice to direct payment holders, or to people interested in receiving direct payments. This condition should not be used to deny a person from receiving a direct payment without consideration of support needs. Consideration should also be given to involving a specialist assessor in determination of support requirements, in particular if one was used earlier in the care and support process (such as assessment).

12.22 In all cases, the consideration of the request should be concluded in as timely a manner as possible. Where the request for a direct payment has been declined, the person in need of care and support, and any other person involved in the request (for example, nominated or authorised person) should (subject to Data Protection Act requirements) receive the reasons in a format that is accessible to them. This should set out which of the conditions in the Care Act have not been met, the reasons as to why they have not been met, and what the person may need to do in the future to obtain a positive decision. The consideration stage should be performed as quickly as is reasonably practicable, and the local authority must provide interim arrangements to meet care and support needs to cover the period in question.

Case Study: Making direct payments support accessible

Abdul is a deafblind man; to communicate he prefers to use Braille, Deafblind Manual and email. He directly employs several staff through direct payments. He receives payroll support from his local direct payments support service. Abdul suggested ways to make direct payments management accessible to him. He communicates with the support service mainly via email but they also use Typetalk.

At the end of the month, Abdul emails the support service with details of the hours that his staff have worked. The support service work out any deductions from pay (such as National Insurance and Income Tax) and email him to tell him how much he should pay the staff via cheque. They then send him pay slips to be given to staff. The envelope that the payslips are sent in has 2 staples in the corner so that he knows who the letter is from. The payslips themselves are labelled in Braille so that he knows which staff to give them to.

Each quarter, the support service tells him how much he needs to pay on behalf of his employees in National Insurance and Income Tax. The service also fills in quarterly Inland Revenue paperwork. At the end of the year, the support service sends relevant information to the council, so that they are aware of how the direct payments are being spent.

Abdul has taken on only some of the responsibilities of employing people; he has delegated some tasks to the support service. Control still remains with Abdul and confidentiality is maintained by using accessible labelling. In terms of the wellbeing principle, the local authority has promoted Abdul's control over his day-to-day life.

12.23 Where the request has been declined, the local authority should continue the care planning process so that it can seek to agree with the person how best to meet the needs, without the use of direct payments (see chapter 10 on care and support planning).

Administering direct payments

12.24 The local authority must be satisfied that the direct payment is being used to meet the care and support needs set out in the plan, and should therefore have systems in place to proportionally monitor direct payment usage to ensure effective use of public money. The Care and Support (Direct Payments) Regulations 2014 set out that the local authority must review the making of direct payments initially within 6 months, and thereafter every 12 months, and must not require information to be provided more often and in more detail than is reasonably required for the purpose of enabling the authority to know that making direct payment is still an appropriate way of meeting the needs, and that conditions upon which it is made are met. Local authorities should not design systems that place a disproportionate reporting burden upon the individual. The reporting system should not clash with the policy intention of direct payments to encourage greater autonomy, flexibility and innovation. For example, people should not be requested to duplicate information or have onerous monitoring requirements placed upon them. Monitoring should be proportionate to the needs to be met and the care package. Thus local authorities should have regard to lowering monitoring requirements for people that have been managing direct payments without issues for a long period.

12.25 The amount of the direct payment is derived from the personal budget as set out in the care and support plan, or support plan, and thus must be an amount which is sufficient to meet the needs the local authority has a duty or power to meet. The direct payment amount will reflect whether the person is required to make any financial contributions, or is requesting a direct payment for only a part of their care and support requirements. Local authorities cannot require financial contributions for a direct payment for after care services under the MHA; these must be provided without charge.

Example: Reduced monitoring

Gina has a stable condition and has been successfully managing her direct payment for over 2 years. The local authority therefore decides to reduce monitoring to the lowest level due to the low perceived risk (while still complying with the required review in the Act and Regulations). Gina is now considered to have the skills and experience to manage on her own unless the local authority request otherwise or information suggested otherwise comes to the attention of the local authority.

12.26 It is ultimately for authorities to decide whether payments are made on a gross or net basis in consultation with appropriate stakeholders. However, local authorities who operate systems of providing gross direct payments should consider the benefits of moving to net payments as these reduce transaction and process costs for both the authority and the person receiving the direct payment. [footnote 50]

12.27 The local authority should have regard to whether there will be costs such as recruitment costs, Employers' National Insurance Contributions, and any other costs by reason of the way in which the adult's needs will be met with the direct payment. [footnote 51] If these costs will be incurred their amount must be included in the personal budget (and thus direct payment) if it is appropriate for the adult to meet the needs in a way which incurs the costs. Some local authorities include one-off payments within the direct payment to cover these factors. In addition, other authorities have commissioned support services such as brokerage, payroll and employment advice as part of their general direct payment offer.

12.28 Where a direct payment recipient is using their payment to employ a personal assistant ( PA) or other staff, the local authority should ensure that there are clear plans in place of how needs will be met in the event of the PA being absent, for example due to sickness, maternity or holiday. Local authorities still have a duty to ensure needs are being met, even if the person makes their own arrangements via the direct payment, so contingencies may be needed. Where appropriate, these should be detailed in the care and support plan, or support plan.

12.29 Specific information should also be given to people about the requirements to have plans in place for redundancy payments due to circumstances such as moving home, a change in care and support needs, or the result of the death of the direct payment holder, or care recipient. If the person meets needs by directly employing someone, they will be responsible for all costs of employment including redundancy payments and this should be made clear to people as part of the information and advice process before a decision is made whether to request direct payments. The local authority must ensure that the direct payment is sufficient to meet these costs if it is appropriate for the adult to meet their needs by employing someone.

12.30 Normally, if someone dies any employment liabilities will be met by the person's estate, but with direct payments local authorities and adults have freedom to develop their own arrangements for dealing with this issue. This could include using any unspent direct payment to contribute to any redundancy costs, having insurance in place that covers redundancy, or the local authority agreeing to cover redundancy payments through the direct payment amount.

12.31 Whatever arrangements are made it is important that the local authority and direct payment holder are both clear as to their responsibilities in this regard to avoid any disputes at a sensitive time for family and carers. Decisions made should be recorded in care plans.

12.32 Local authorities should also consider how to recover unspent direct payments if the recipient dies. For example, if someone wishes to pay an agency in advance for its services, the local authority should bear in mind that it may be difficult to recover money paid for services that were not in fact delivered. Local authorities should also consider, if the direct payment recipient does leave unspent funds to be recovered, that before their death the direct payment recipient may have incurred liabilities that should legitimately be paid for using the direct payments (for example, they received services for which payment had not been made at the time of death). Local authorities may need to consider any redundancy costs payable to personal assistants and be prepared to provide advice on how these might be met. As with other costs the personal budget must be a sufficient amount to meet the person's needs, including the provision of any redundancy costs, if appropriate to meet needs, and subject to other arrangements that may have been made.

12.33 Local authorities should ensure all direct payment recipients are supported and given information in regards to having the correct insurance cover in place. Direct payments recipients should be given support to understand the benefits that insurance cover can provide, and the direct payment should therefore include an amount to cover the cost of employers' liability insurance and any other insurance that is required in order that the person can meet their needs in the way specified in the care plan.

12.34 The local authority must also have regard to where the direct payment can be integrated with other forms of public funding, such as personal health budget direct payments. Where this is apparent, the local authority should take steps to work with partners to combine the payments, as long as the person and all parties agree. For example, the local authority could agree with the NHS that the social care and health direct payments are combined and that the monitoring is performed solely by one organisation, reporting to the other as appropriate. This will avoid the person having multiple bank accounts, and having to supply similar information to public bodies to account for direct payment spend, while allowing both bodies to meet their statutory responsibilities.

Using the direct payment

Paying family members

12.35 The direct payment is designed to be used flexibly and innovatively and there should be no unreasonable restriction placed on the use of the payment, as long as it is being used to meet eligible care and support needs.

Example: Direct Payment to pay a family member for administration support

David has been using direct payments to meet his needs for some time, and has used private agencies to provide payroll and administration support, funded by a one-off annual payment as part of his personal budget allocation. David's wife, Gill provides care for him and is increasingly becoming more hands-on in arranging multiple PAs to visit and other administrative tasks as David's care needs have begun to fluctuate.

They jointly approach the local authority to request that Gill undertake the administration support instead of the agency as they want to take complete control of the payment and care arrangements so that they can best meet David's fluctuating needs and ensure that appropriate care is organized.

The local authority considers that Gill would be able to manage this aspect of the payment, and jointly revises the care plan to detail the aspects of the payment, and what services Gill will undertake to the agreement of all concerned. The personal budget is also revised accordingly.

The family now has complete control of the payment, Gill is reimbursed for her time in supporting David with his direct payment and the local authority is able to make a saving in the one-off support allocation as there are no provider overheads to pay. In promoting David's wellbeing, the local authority has demonstrated regard for the balance between promoting an individual's wellbeing and that of people who are involved in caring for them. It has given Gill increased control in a way that David is comfortable with and supports.

12.36 The 2009 Direct Payment Regulations excluded the payment from being used to pay for care from a close family member living in the same household, except where the local authority determined this to be necessary. [footnote 52] While the Care and Support (Direct Payments) Regulations 2014 maintain this provision regarding paying a family member living in the same household for care, it provides a distinction between 'care' and 'administration/management' of the direct payment. This allows people to pay a close family member living in the same household to provide management and/or administrative support to the direct payment holder in cases where the local authority determines this to be necessary. This is intended to reflect the fact that in some cases, especially where there are multiple complex needs, the direct payment amount may be substantial.

Example: Direct payment paid to a family member where necessary

James has severe learning difficulties as well as various physical disabilities. He has serious trust issues and a unique way of communicating that only his family, through years of care as a child, can understand. The local authority agrees that using a direct payment to pay for care from his parents is necessary as it is the best way to meet James's needs and outcomes.

12.37 The management and administration of a large payment, along with organising care and support can be a complex and time consuming task. This allows family members performing this task to be paid a proportion of the direct payment, similar to what many direct payment holders pay to third-party support organisations, as long as the local authority allows this.

12.38 This is not intended to be income replacement, and people interested in requesting this option should be informed of tax and employment implications, any impacts upon other benefits and given (or signposted to) information and advice to help them decide. The local authority should be satisfied that it is necessary to make the payment to the family member to provide this service and that the direct payment will only be used for administration and management of the payment. The circumstances and payment amount should be decided and agreed with the person requiring care and support, the family member, local authority and any other person (for example, advocate), with the local authority taking steps to ensure all parties agree.

12.39 These decisions should be recorded in the care plan and include the amount of the payments, their frequency and the activities that are covered. This arrangement must also be taken into account during allocation of the personal budget so that the amount remains sufficient to meet the person's needs.

12.40 Local authorities will need to have in place agreement between all parties about what steps to take in case of a dispute regarding the management of the payment by a household family member. This will be especially relevant where the person providing administrative and management is also the nominated or authorised direct payment recipient. It would not be appropriate to allow this where there is a risk that the direct payment may be abused, or there are other sensitivities such as potential safeguarding issues.

Short-term care in a care home

12.41 Direct payments cannot currently be used to pay for people to live in long-term care home placements. They can be made to enable people to purchase for themselves a short stay in care homes, provided that the stay does not exceed a period of 4 consecutive weeks in any 12-month period. This could be used to provide a respite break for a carer, for example.

12.42 The Regulations specify that where the interim period between 2 stays in care homes is less than 4 weeks, then the 2 stays should be added together to make a cumulative total, which should also not exceed 4 weeks if it is to be paid for with direct payments. On the other hand, if 2 stays in care homes are more than 4 weeks apart then they are not added together.

12.43 Once a direct payment recipient has had 4 consecutive weeks in care homes, or 2 or more periods separated by less than 4 weeks which added together total 4 weeks, then they cannot use their direct payments to pay for any more home services care until 12 months have passed from the start of the 4-week period. On the other hand, as long as each stay is less than 4 weeks and there is an interim period of at least 4 weeks between 2 or more stays which added together exceed 4 weeks, then the service recipient may use their direct payments to pay for residential breaks throughout the year.

Example: Direct Payments for short-term residential care

Mrs. H has one week in a care home every 6 weeks. Because each week in a care home is more than 4 weeks a part, they are not added together. The cumulative total is only one week and the 4-week limit is never reached.

Peter has 3 weeks in a care home, 2 weeks at home and then another week in a care home. The 2 episodes of time in a care home are less than 4 weeks apart and so they are added together making 4 weeks in total. Peter cannot use his direct payments to purchase any more care home services within a 12-month period.

12.44 People can receive additional weeks in a care home once they have reached the 4-week maximum. They cannot purchase the stay using their direct payments, but if the local authority and the person agrees that a longer stay is needed, it can still arrange and fund stays for the person. There is no restriction on the length of time for which the local authority may arrange such accommodation for someone (see chapter 8 for guidance on choice of accommodation).

12.45 The time limit is imposed to promote people's independence and to encourage them to remain at home rather than moving into long-term home placement. Where a person is constantly using the direct payment to pay for a short-term care home stays, the local authority should consider whether to conduct a review to ensure that the care plan is still meeting needs.

Long-term care in a care home

12.46 People who are living in care homes may receive direct payments in relation to non-residential care services. For example, they may have temporary access to direct payments to try out independent living arrangements before making a commitment to moving out of their care home. Direct payments can also be used by people living in care homes to take part in day-time activities. This can be particularly empowering for young people in transition (see chapter 16).

12.47 Direct payments cannot currently be used to secure long-term stays in a care home. Approaches to the use of direct payments in care homes have been trialled in a number of local authorities which were designated trailblazers and specified in the regulations The learning from this trailblazer programme will be used to develop additional statutory guidance for local authorities when direct payments for long-term stays in care homes is introduced for all local authorities in 2020. Trailblazers were asked if they wished to remain on the schedule of those local authorities not prohibited from making a direct payment for the purposes of securing long term care in a care home until national rollout in 2020 and the regulations were amended accordingly.

Becoming an employer

12.48 Local authorities should give people clear advice as to their responsibilities when managing direct payments, and whether the person in receipt of direct payments needs to register with HM Revenue & Customs ( HMRC) as an employer. Becoming an employer carries with it certain responsibilities and obligations, in particular to HMRC and people need to be aware of these before agreeing to take up a direct payment. Disability and tax - a guide provides information on being an employer.

12.49 The local authority should consider using the proportionality principle, whether to carry out checks to make sure any PAYE income tax and National Insurance contributions deducted from an employee's pay is in turn paid over to HMRC, and that employment payments do not breach the national minimum wage and conform to pension requirements if eligible. Some people may not need this check to be performed, but it may be more appropriate in other cases and conform to pension requirements if eligible. [footnote 53]

Where it becomes clear that payments, or returns detailing employee information deductions, have not been made, or that the individual is failing to meet their obligations as an employer generally, the direct payment scheme should be reviewed and consideration given to whether alternative arrangements that result in the direct payment recipient no longer acting as the employer need to be made. Not doing so may result in the individual building up arrears of tax and National Insurance due to HMRC, which may then lead to enforcement action to recover any debt. This situation should be able to be avoided by effective monitoring where appropriate, and by providing clear, accessible upfront information about the responsibilities of becoming an employer. Many local authorities have commissioned voluntary and charity organisations to provide support to direct payment holders on these matters.

12.51 Where a person wishes to directly employ their own PA, the local authority should also have regard to the guidance published by Skills for Care detailing minimum levels of support for individual employers and PAs. This guidance recommends local authorities should provide on-going support through access to training activities in a variety of ways and promote the Workforce Development Fund. It also proposes that local authorities promote apprenticeships for PAs.

Direct payments and hospital stays

12.52 There may often be occasions when direct payment holders require a stay in hospital. However, this should not mean that the direct payment must be suspended while the individual is in hospital. Where the direct payment recipient is also the person requiring care and support, consideration should be given to how the direct payment may be used in hospital to meet non-health needs or to ensure employment arrangements are maintained. Suspending or even terminating the payment could result in the person having to break the employment contract with a trusted personal assistant, causing distress and a lack of continuity of care when discharged from hospital.

12.53 In these cases, the local authority should explore with the person, their carer and the NHS the options to ensure that both the health and care and support needs of the person are being fully met in the best way possible. For example, the person may prefer the personal assistant to visit hospital to help with personal care matters. This may be especially so where there has been a long relationship between the direct payment holder and the personal assistant. This should not interfere with the medical duties of hospital personnel, but be tailored to work alongside health provision.

12.54 In some cases, the nominated or authorised person managing the direct payment may require a hospital stay. In these cases, the authority must conduct an urgent review to ensure that the person continues to receive care and support to meet their needs. This may be through a temporary nominated/ authorised person, or through short-term authority arranged care and support.

Example: Using a direct payment whilst in hospital

Peter is deafblind and is required to stay in hospital for an operation. Whilst the hospital pays for an interpreter for the medical interventions, Peter needs additional support to be able to move around the ward, and to communicate informally with staff and his family. The local authority and the NHS Trust agree that Peter's communicator guide continues to support him in hospital, and is paid for via the direct payment, as it was when Peter was at home. Personal and medical care is provided by NHS staff but Peter's communicator guide is on hand to provide specialist communication and guiding support to make his hospital stay is as comfortable as possible.

Direct payments for local authority services

12.55 As a general rule, direct payments should not be used to pay for local authority-provided services from the 'home' local authority. Where a person wishes to receive care and support from their local authority, it should be easier and less burdensome to provide the service direct to the person. This will also avoid possible conflicts of interest where the local authority is providing the direct payment, but also promoting their services for people to purchase.

12.56 There may be cases where the local authority exercises discretion to provide care and support by receiving a direct payment amount, for example this could be where a person who is using direct payments wants to make a one-off purchase from the local authority such as a place in day care. In these cases, the local authority should take into account the wishes of the person requiring care and support when making a decision. In one off cases such as these, it may be less burdensome to accept the direct payment amount, rather than providing the service and then reducing the personal budget and direct payment accordingly.

Example: Local authority provided service

Graham has a direct payment for the full amount of his personal budget allowance. He decides to use a local authority run day service on an infrequent basis and requests to pay for it with his direct payment so that he retains flexibility about when he attends. The local authority service is able to agree to this request and has systems already in place to take payments as self-funders often use the service. The authority advise Graham that if he wishes to use the day service on a frequent basis (for example, once a week) it would be better to provide the service to him direct, and to reduce the direct payment amount accordingly.

12.57 This does not preclude people from using their direct payment to purchase care and support from a different local authority. For example, a person may live close to authority boundaries and another local authority could provide a particular service that their 'home' authority does not provide.

Direct payments in the form of pre-paid or pre-payment cards

12.58 Many local authorities have been developing the use of pre-paid cards as a mechanism to allow direct payments without the need for a separate bank account, or to ease the financial management of the payment. Whilst the use of such cards can be a useful step from managed services to direct payments, they should not be provided as the only option to take a direct payment The offer of a 'traditional' direct payment paid into a bank account should always be available if this is what the person requests and this is appropriate to meet needs. Consideration should be given to the benefit gained from this arrangement as opposed to receiving the payment via a pre-paid card.

12.59 It is also important that where a pre-paid card system is used, the person is still free to exercise choice and control. For example, there should not be blanket restrictions on cash withdrawals from pre-paid cards which could limit choice and control. The card must not be linked solely to an online market-place that only contains selected providers in which to choose from. Local authorities should therefore give consideration to how they develop card systems that encourage flexibility and innovation, and consider consulting care and support user groups on any proposed changes to direct payment processes.

Harmonisation of direct payments

12.60 In circumstances where it is in the person's interest to combine the plan and budget with another form of state support (such as personal health budgets), and the person agrees that plans should be combined, the local authority should give consideration to whether the person is receiving direct payments from partner organisations, such as the NHS. If so, attempts should be made to harmonise the direct payments so that the person does not have multiple payments each with their own monitoring regime. For example, the local authority could work with the NHS partner to agree on a 'lead organisation' that oversees the overall budget and monitors the direct payments to ensure they are being to meet both health and care needs, while still allowing both bodies to satisfy themselves of their statutory responsibilities.

Reviewing direct payments

12.61 In addition to monitoring direct payments generally to ensure they are being used to meet care and support needs, the Regulations set out that local authorities must also review the making of the direct payment within the first 6 months of making the first payment. This provision is intended to be used for direct payments made under the powers in the Care Act, rather than pre-existing ones.

12.62 This review is intended to be light-touch to ensure that the person is comfortable with using the direct payment, and experiencing no initial issues. It should ideally be incorporated within the initial review of the care and support plan 6-8 weeks after sign-off and include elements such as managing and using the direct payment and a discussion to consider any long-term support arrangements that may be appropriate such as payroll, insurance cover and third party support. Local authorities should ensure that reviewing officers are appropriately trained to review direct payments (for example are familiar with financial procedures and employment laws) This review is not intended to be a full review of the person's care and support plan. However, if this review raises concerns or requires actions that affect the detail recorded in the care plan, then a full review of the plan would need to be carried out.

12.63 If the direct payment recipient is employing people, the local authority should as part of the review, consider checking, if appropriate, to ensure the individual is fulfilling their responsibilities as the employer, in particular that they are submitting PAYE returns to HMRC as well as paying tax and National Insurance deductions made to HMRC.

12.64 The Regulations also set out that following the 6-month review, the local authority must then review the making of the direct payment no later than every 12 months. In practice, after the initial 6-month review period, local authorities may wish to consider aligning the annual review of the direct payment with the general review of the care plan. This will reduce bureaucracy and allow the local authority to review both at the same time.

12.65 Where a direct payment is being allocated to a nominated/authorised person, or where there may be a family carer being paid for administrative support, the review should incorporate all of these parties as well as the person in need of care and support. This will ensure that the local authority receives views from everyone involved in the direct payment, so that it can satisfy itself that there are no initial issues that require resolving.

12.66 The outcome of the review should be written down, and a copy given to all parties. Where there are issues that require resolving, the resolution method should be agreed with all parties involved, as far as is reasonably practicable. Where appropriate, local authorities should advise people of their rights to access the local authority complaints procedure.

Terminating direct payments

12.67 Direct payments should only be terminated as a last resort, or where there is clear and serious contradiction of the Regulations or where the conditions in sections 31 or 32 of the Act are no longer met (except in cases of fluctuating capacity - see sections below). Local authorities should take all reasonable steps to address any situations without the termination of the payment. Effective, but proportionate monitoring processes will help local authorities to spot any potential issues before a termination is necessary.

12.68 If terminating a direct payment, the local authority must ensure there is no gap in the provision of care support. Where a decision has been made to terminate a direct payment, the local authority should conduct a revision of the care and support plan, or support plan, to ensure that the plan is appropriate to meet the needs in question (see Chapter 13 on reviews).

Reasons for discontinuing direct payments

12.69 A person to whom direct payments are made, whether to purchase support for themselves or on behalf of someone else, may decide at any time that they no longer wish to continue receiving direct payments. In these cases, the local authority should ensure there are no outstanding contractual liabilities, and conduct a review of the care plan to consider alternate arrangements to meet needs.

12.70 The Care Act also sets out that a local authority shall cease making direct payments if the person no longer appears to be capable of managing the direct payments or of managing them with whatever support is necessary.

12.71 Direct payments should be discontinued when a person no longer needs the support for which the direct payments are made. This might happen in situations where the direct payments are for short-term packages when leaving care home or hospital. Direct payments for after-care services under section 117 of the Mental Health Act would also cease once the clinical commissioning group and local authority are satisfied that the person concerned is no longer in need of such services.

12.72 There may be circumstances in which the local authority discontinues direct payments temporarily. An example might be when an individual does not require assistance for a short period because their condition improves and they do not require the care and support that the direct payments are intended to secure. The local authority will need to discuss with the person, their carer, and any other person how best to manage this. The person should be allowed to resume responsibility for their own care after the interruption, if that remains their wish, unless there has been a change of circumstances which means that the conditions in the Act and/or Regulations are no longer met. If there is a change of circumstances that affects the care plan/support plan the local authority must revise the plan to ensure that it is still meeting needs (see Chapter 13).

12.73 The local authority might also discontinue payments if the person fails to comply with a condition imposed under regulations to which the direct payments are subject or if for some reason the local authority no longer believes it is appropriate to make the direct payments. For example, the local authority might discontinue the direct payment if it is apparent that they have not been used to achieve the outcomes of the care plan.

12.74 The 2009 Direct Payment regulations set out that direct payments must not be provided under certain conditions, such as where the recipient is placed by the courts under a condition or requirement relating to a drug and/or alcohol dependency. The Care and Support (Direct Payments) Regulations 2014 retain this universal restriction. The groups and conditions remain substantially the same as the 2009 regulations and are set out in the schedule to the 2014 regulations.

12.75 Where direct payments are discontinued as a result of criminal justice legislative provisions, the local authority should make timely arrangements for services to be provided in lieu of the direct payments, to ensure continuity of support.

Discontinuing direct payments in the case of persons with capacity to consent

12.76 Where someone with capacity was receiving direct payments but then loses capacity to consent, the local authority should discontinue direct payments to that person and consider making payments to an authorised person instead. In the interim, the local authority should make alternative arrangements to ensure continuity of support for the person concerned.

12.77 If the local authority believes the loss of capacity to consent to be temporary, it may continue to make payments if there is someone else who is willing to manage payments on the person's behalf. This situation should be treated as strictly temporary and closely monitored to ensure that, once the person has regained capacity, they are able to exercise overall control over the direct payments as before. If the person's loss of capacity to consent becomes prolonged, then the local authority should consider making more formal arrangements for an authorised person to take over receipt of the direct payments on that person's behalf. The local authority should make clear that the arrangement is designed to be temporary, so that the person managing the direct payment does not enter into any long-term contractual arrangements.

Discontinuing direct payments in the case of persons lacking capacity to consent

12.78 Direct payments must be discontinued if the local authority is no longer satisfied for whatever reason that the authorised person is acting in the best interests of the beneficiary, within the meaning of the 2005 Act. The local authority might also wish to discontinue the direct payments if it has sufficient reason to believe that the conditions imposed under regulations on the authorised person are not being met. The authority may wish to consider if someone else can act as an authorised person for the person lacking capacity, or whether it will have to arrange services for them in place of the direct payments.

12.79 Direct payments under section 32 of the Act must be discontinued where the local authority has reason to believe that someone who had lacked capacity to consent to direct payments has now regained that capacity on a long-term or permanent basis. The authority should not terminate direct payments to the authorised person before beginning to make direct payments to the service recipient themselves or to arrange services for them, according to their wishes. If the local authority is satisfied that the regaining of capacity will only be temporary, then it can continue to make direct payments to the authorised person if during the period that the adult has the capacity to make the request and is capable of managing the direct payment, the adult will manage the payments for him or herself.

How to discontinue direct payments

12.80 In all cases, as soon as possible the local authority should discuss with individuals, their carers and any person managing the direct payments if it is considering discontinuing direct payments to them, in order to explore all available options before making the final decision to terminate the direct payments. For example, if ability to manage is an issue, the individual should be given an opportunity to demonstrate that they can continue to manage direct payments, albeit with greater support if appropriate. The local authority should not automatically assume when problems arise that the only solution is to discontinue or end direct payments.

12.81 If the local authority does decide to withdraw direct payments, it will need to conduct a review of the plan and agree alternative care and support provision with the person, their carer and independent advocate if they have one, unless the withdrawal was following a review after which the local authority concluded that the services were no longer needed A minimum period of notice should be established that will normally be given before direct payments are discontinued. This should be included in the information to be provided to people who are considering receiving direct payments.

12.82 It will be extremely unlikely that a local authority will discontinue direct payments without giving notice, although in serious cases this may be warranted (for example, the authorised person is not acting in the best interests of the person). Local authorities should explain to people, before they begin to receive direct payments, the exceptional circumstances in which this might occur and discuss with them the implications this has for the arrangements that individuals might make.

12.83 If direct payments are discontinued, some people may find themselves with ongoing contractual responsibilities or having to terminate contracts for services (including possibly making employees redundant). Local authorities should take reasonable steps to make people aware of the potential consequences if direct payments end, and any obligations they may have.

12.84 There may be circumstances where the person has lost the capacity to manage the direct payment and there is no-one else to manage the payment on their behalf, or where a person needs additional support to terminate arrangements. In these cases the local authority should have regard as to whether it needs to step in or provide support to ensure that any contractual arrangements are appropriately terminated to ensure that additional costs are not incurred.

13. Review of care and support plans

This chapter provides guidance on section 27 of the Care Act 2014 and covers:

13.1 Ensuring all people with a care and support plan, or support plan have the opportunity to reflect on what is working, what is not working and what might need to change is an important part of the planning process. It ensures that plans are kept up to date and relevant to the person's needs and aspirations, provides confidence in the system and mitigates the risks of people entering a crisis situation.

13.2 The review process should be person-centred and outcomes-focused, as well as accessible and proportionate to the needs to be met. The process must involve the person needing care and also the carer where feasible, and consideration must be given whether to involve an independent advocate who local authorities are required to supply in the circumstances specified in the Act.

13.3 Reviewing intended outcomes detailed in the plan is the means by which the local authority complies with its ongoing responsibility towards people with care and support needs. The duty on the local authority therefore is to ensure that a review occurs, and if needed, a revision follows this. Consideration should also be given to authorising others to conduct a review - this could include the person themselves or carer, a third party (such as a provider) or another professional, with the local authority adopting an assurance and sign-off approach.

13.4 The review will help to identify if the person's needs have changed and can in such circumstances lead to a reassessment. It should also identify other circumstances which may have changed, and follow safeguarding prin

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The Health and Care Act 2022 revoked Schedule 3 and amended Section 74 of the Care Act 2014 on 1 July 2022. This means that certain parts of this guidance are out of date and in the process of being updated to reflect the relevant statutory changes.

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Home Ownership for People with Long-term Disabilities (HOLD)

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Home Ownership for People with Long-term Disabilities (HOLD)

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Adults with disabilities or long-term health conditions may be able to own their own home through a scheme called HOLD.

HOLD offers adults with disabilities the chance to buy a home on the open market under a special shared-ownership scheme. They must have an annual income of less than £80,000 and must not already be living in a home that they already own.

For more information click these links:

Own Your Home | Home Ownership for People with Long-Term Disabilities (HOLD) - Own Your Home

HOLD and shared ownership and step by step guide_FINAL.pdf (local.gov.uk)

Mortgage affordability and benefits | Disability charity Scope UK

Shared ownership homes: buying, improving and selling: Who can apply - GOV.UK (www.gov.uk)

HOLD Shared Ownership for People with Long-Term Disabilities | Advance Housing (advanceuk.org)

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What is Shared Ownership? | Central Bedfordshire Council

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The law states that people aged 18+ are adults and are therefore free to make their own independent decisions about how they live and where they go. It is against the law to prevent an adult from being free to make choices for themselves, unless they are deemed to lack the capacity to make these decisions under the Mental Capacity Act 2005.

Adults with disabilities, particularly learning disabilities, may need to be constantly supervised by other people and may not be free to leave their home whenever they want to because they need to be kept safe. If they do not have the mental capacity to agree to their own care arrangements, the Mental Capacity Act says that a court will need to grant a Deprivation of Liberty order (DoL) for the person, which sets out the reasons why some of their freedoms have to be restricted in order to keep themselves and others safe from harm. A DoL has to be regularly reviewed by the court to safeguard the adult against any unnecessary restrictions that could be put upon them. An adult who is continuing to live with their family carers would generally not need a DoL order form the court, but may need one if they move out of the family home and live within a residential or non-residential setting and require care and support that they do not have the capacity to agree to themselves. The rules around Deprivation of Liberty orders are governed by the Deprivation of Liberty Standards (DoLS) as set out in the Mental Capacity Act 2005.

An adult's social worker and/or care provider will normally be responsible for applying to the court for the DoL order and for reviewing this regularly. When major decisions about changes to a person's care are being made for them, a new DoL application will need to be made to the court to explain why the decision has to be made for them and who will be making it. Family carers should contribute to the DoL application to express their views about the changes being proposed.

Use the links below to find out more information about DoL orders the the DoLS:

Deprivation of liberty - Mind

Understanding when someone is deprived of their liberty | The Law Society

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What are the Deprivation of Liberty Safeguards? Maria Nicholas 020 8492 2290

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Find out more about other financial help that may be available to you here: What benefits can you claim if you're a carer? - Sense