The Care Act 2014 is arguably the most significant piece of legislation for social workers who work with adults, since the NHS and Community Care Act 1990. This book presents the information from the act, regulations and statutory guidance in a way that provides social workers with a good understanding of the legislation and how it applies to their role.
Making extensive use of case examples that derive from the author's experience as a social worker, the book highlights the circumstances where professional judgment is required and explores issues that need interpretation such as significant impact on wellbeing.
It covers the key stages of the 'care and support journey' - first contact, assessment of needs, prevention, consideration of eligibility, charging and financial assessment, care and support planning, and review. In addition, other chapters look at significant issues such as safeguarding and working with NHS colleagues.
This book helps to improve the 'legal literacy' of social workers, i.e. the connecting of legal rules with professional priorities and ethical practice. It achieves this by helping social workers to better understand the legal framework within which they make professional judgements, and to apply their expertise in interpreting the law for the benefit of people with care and support needs.
This readable and jargon-free book provides:
- a solid foundation for social work students in developing a critical understanding of the Care Act and its application,
- help for experienced social workers with developing the critical reflection necessary to enhance their ability to make professional judgements
- a source of reference which social workers can use to evaluate their local systems, policies and procedures.
About the Author
Pete is a freelance Care Act consultant and trainer. He has a background of working in many sectors of social care as a social worker, trainer, manager and policy developer. He was a member of the team that developed learning materials for the Care Act for Skills for Care. He is currently providing Care Act training for local authorities and for BASW. He was previously a member of the board of Skills for Care (November 2012 - November 2014). He has written articles on the Care Act published in Professional Social Work, and also ‘The A-Z of the Care Act 2014’ for Community Care Inform.
Read an Excerpt
The Social Worker's Guide to the Care Act 2014
By Pete Feldon
Critical Publishing LtdCopyright © 2017 Pete Feldon
All rights reserved.
People will have their first contact with social care in a range of different ways. Sometimes it will be as a result of a crisis, or it could simply be an enquiry from someone anticipating that they might need help in the future. The contact might be directly with the local authority or the individual could be referred by another organisation, such as when someone is being discharged from hospital or where the individual has made an enquiry with a local voluntary organisation.
Where this first contact is in relation to someone who appears to have care and support needs or a carer who appears to have support needs, then a needs assessment or a carer's assessment must be offered. In addition to initiating the assessment, the first contact process must include steering people towards preventative services and sources of specialist advice and information.
This chapter focuses on the commencement of a needs or carer's assessment at the point of first contact, whether this is via a specialist first contact team or through other means such as planning for a discharge from hospital.
Although social workers are mostly not involved directly in the first contact process, they need to have a good understanding of how it works because they will be taking over cases either straight away, or after an intermediary stage such as reablement.
This chapter comprises the following sections:
First contact prior to April 2015
Key terms and definitions
The essential features of first contact
The gateway to assessment
First contact teams
Initial assessment at first contact
Applying the guidance using case examples
There is a strong emphasis in the statutory guidance on enabling people to make well-informed decisions throughout the care and support journey, and this is particularly important during first contact. Staff responsible for the first contact have a role in making sure that individuals who contact them understand how the care and support system might apply to their circumstances, and signposting them to sources of specialist information.
First contact prior to April 2015
Section 47 (1) of the NHS and Community Care Act 1990 stated that "where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority – (a) shall carry out an assessment of his needs for those services".
Carers had a right to request an assessment of their needs under the Carers (Recognition and Services) Act 1995 and the Carers and Disabled Children Act 2000. Section 1 (1) of the former stated that where "an individual ('the carer') provides or intends to provide a substantial amount of care on a regular basis for the relevant person, the carer may request the local authority, before they make their decision as to whether the needs of the relevant person call for the provision of any services, to carry out an assessment of his ability to provide and to continue to provide care for the relevant person".
The previous statutory guidance was issued in 2010 in Prioritising Need in the Context of Putting People First: A Whole System Approach to Eligibility for Social Care. In paragraph 73 it stated that "before starting a community care assessment councils should first ascertain whether a person appears to be in need of community care services regardless of whether and how those needs are currently being met". This statutory guidance did not add anything in relation to the initial assessment of carers.
The essential features of first contact
1. The key factor in determining if a needs assessment must be considered for an adult, or a carer's assessment for a carer, is whether the individual has an appearance of need.
2. Once an appearance of need is determined, the duty to assess is triggered. The first contact is the initial part of the assessment process.
3. An assessment must be initiated regardless of whether the individual is thought to have eligible needs or to be a self-funder.
4. At this stage it must be ascertained whether the individual is able to be involved in their assessment, or whether they have substantial difficulty in doing so.
5. Once an assessment has commenced, it can be concluded only in one of two ways. Either the person being assessed declines further assessment, or the assessment continues until eligibility has been determined.
6. The first contact can often be at a time of crisis and the individual may have urgent needs for care and support.
7. Urgent needs can be met regardless of whether the individual meets the ordinary residence requirement.
8. This initial stage of the assessment can be undertaken through a telephone conversation or online.
9. At the conclusion of the first contact the person being assessed should be clear about the next steps and be given an indication of timescales.
10. Staff involved in first contact must have access to support from social workers and other professionally qualified staff, or be social workers or qualified professionals themselves.
The gateway to assessment
A needs assessment or a carer's assessment cannot take place unless it has been established that someone appears to have needs for care and support (or for support in the case of a carer).
The statutory guidance does not give any definition of 'appearance of need'. By using the term 'appearance' it sets a low threshold for assessment, and means that an assessment ought to be carried out for any adult who may have needs for care and support, and any carer who may have needs for support.
Appearance of need is the only criteria identified for a person to be considered for an assessment. The Care Act underscores this by identifying what cannot be taken into account in section 9 (3):
"The duty to carry out a needs assessment applies regardless of the authority's view of –
a) the level of the adult's needs for care and support, or
b) the level of the adult's financial resources."
Being ordinarily resident in a local authority area is not a requirement where a person has urgent needs, as specified in section 19 (3) of the Care Act. The only other reference to ordinary residence in relation to assessment is in paragraph 6.134 of the statutory guidance where it is set out what a local authority must do if an adult has eligible needs, and one of these requirements is to "establish whether the person meets the ordinary residence requirement".
Paragraph 6.16 clarifies that a carer is an individual who "provides or intends to provide care for another adult", and would qualify for an assessment where "it appears that the carer may have any level of needs for support". Someone who provides "care under contract (e.g. for employment) or as part of voluntary work" (paragraph 6.16) is not normally regarded as a carer in the sense that this term is used in the Act, regulations and statutory guidance.
First contact teams
Most local authorities have specialist teams that respond to people making contact with a local authority for the first time about social care. These teams also receive and process referrals from other organisations.
The revised statutory guidance endorses the setting up of specialist teams to get "the initial response right" (paragraph 6.24). This paragraph notes that "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".
Most local authorities have acted on the suggestion in paragraph 3.25 that the first point of contact is one means by which they can "provide – or signpost to – advice and information when people in need of care and support come into contact with them".
These teams are organised in a number of different ways, and have a range of different names ranging from the straightforward 'Access Team' to snappier titles such as 'Choices'. Some comprise both office-based staff who provide the initial response and social workers who undertake initial assessments. In other local authorities the staff providing the initial response are part of an information and advice team that makes the decision about whether there is an 'appearance of need'. Or in some cases there is a corporate call-handling team that does not make the 'appearance of need' decision and forwards on the request for assessment to the relevant team.
Where first contact teams do not include social workers, arrangements should be made so that staff "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" (paragraph 6.27).
For some people the route to assessment may not be via a first contact team, eg where potential care and support needs are first identified when someone is in hospital, social workers often manage all of the initial response. Also, for people whose most significant needs are because of mental illness or learning disability, the initial assessment of care and support needs may be part of a multi-disciplinary assessment. Carers will always be offered an assessment of their support needs in conjunction with the adult, but for some people the starting point could be the carer requesting an assessment, and this could come via a local carers organisation.
Initial assessment at first contact
Paragraph 6.22 is clear that the "assessment process starts from when local authorities start to collect information about the person".
The previous statutory guidance issued in 2010 in Prioritising Need in the Context of Putting People First: A Whole System Approach to Eligibility for Social Care distinguished between first establishing an individual's 'presenting needs' and then going on to determine if they had 'eligible needs'. But no such distinction exists in the Care Act 2014 or the statutory guidance.
In deciding how to organise the initial stage of assessments of need, either through a team specialising in first contact or through some other means such as hospital discharge, local authorities will have to make their own policy and practice decisions about how to apply the statutory guidance in relation to information and advice, appropriateness and proportionality, involvement, meeting urgent needs and ending an assessment.
Information and advice
It is specified in paragraph 6.22 that an individual "must be given as much information as possible about the assessment process, as early as possible". This information should include detail of what can be expected during the assessment process" and:
the format and timescale of assessment;
possible access to independent advocacy.
In addition paragraph 6.38 states "the local authority should provide in advance, and in an accessible format, the list of questions to be covered in the assessment ... (to) help the individual or carer prepare for their assessment and think through what their
needs are and the outcomes they want to achieve". Paragraph 6.22 also states that local authorities "must ensure that this information is in an accessible format for those to whom it is provided", eg in Braille for people who have a sight impairment.
Chapter 3 of the statutory guidance sets out the general duty placed on the local authority to provide information and advice in relation to care and support, some of which is particularly relevant to first contact. In paragraph 3.33 reference is made to research findings that "people 'don't know what they need to know' in relation to their care and support". Paragraph 3.35 states that in providing an information and advice service, local authorities should assist "people to navigate all points and aspects of their journey through care and support".
Paragraph 3.23 says that local authorities must ensure that information and advice is provided on "the care and support system locally – about how the system works", and that this will include an "outline of what the 'process' may entail and the judgements that may need to be made" and also "specific information on what the assessment process, eligibility, and review stage is, how to complain or make a formal appeal to the authority, what they involve and when independent advocacy should be provided".
An example is given in paragraph 6.101 of how the early provision of information and advice "would delay a person from developing needs which meet the eligibility criteria" and that this would also help individuals 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".
Appropriateness and proportionality
Local authorities must ensure that an individual "receives a proportionate assessment which identifies their level of needs" (paragraph 6.28), and in doing so it may be appropriate for the assessment to be "carried out over the phone or online". A caveat is added that these methods may not be appropriate in some circumstances, particularly 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". In these circumstances "a face-to-face assessment should be arranged".
Difficulties with involvement
The general duty of local authorities to consider whether individuals "would have substantial difficulty in engaging with the local authority care and support processes" (paragraph 7.10) will be applicable at first contact. Paragraph 6.23 states: "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." The implications of having difficulties with involvement are considered in more depth in Chapter 10.
Meeting urgent needs
Staff who receive approaches from people with urgent needs or referrals from other organisations will be responsible for initiating the exercise of the local authority's power to "provide an immediate response and meet the individual's care and support needs" (paragraph 6.26). This can be done by making arrangements to meet these needs, or "an immediate referral may be the best way to meet a person's urgent needs" (paragraph 6.26). It may be that their urgent needs are best met by the NHS.
Urgent needs can be met without taking into account ordinary residence and finances (see paragraph 6.26).
Ending the assessment
Unless people choose to end their assessment, it ought to continue until it concludes with the determination of eligibility. The statutory guidance does not suggest any alternatives.
An individual "may choose not to have an assessment because they do not feel that they need care or they may not want local authority support" (paragraph 6.20), and in these circumstances the local authority is not required to undertake an assessment. However, section 11 (2) specifies that an assessment must take place where an adult says that he or she doesn't want one if either of the two following circumstances apply:
a. the adult lacks mental capacity and it would be in their best interests;
b. the adult is experiencing, or is at risk of experiencing, abuse or neglect.
Applying the guidance using case examples
What follows in this section are three examples that have been constructed to illustrate and analyse some of the typical aspects of first contact that are of particular relevance for social workers.
The cases used in this chapter will also be used in subsequent chapters of Part I to illustrate each person's journey through the care and support system.
Chapter 10 considers all stages of the care and support journey for people who lack mental capacity or have substantial difficulty, so examples are not given in this chapter and in subsequent chapters of Part I.
Each case, and the subsequent analysis, is set out using the following headings:
Commencing of an assessment;
Concluding first contact.
The first case also considers the following:
Meeting urgent needs.
Comment and analysis
Readers should note that what is set out in this section and the previous section is intended to show how the statutory guidance might be applied, and in doing so, what would be complex situations in real life have had to be simplified.
Commencing an assessment
It is probable that the majority of people who make contact with their local authority for help with social care will meet the threshold criteria for the appearance of need. Those who don't will usually be people who have other needs, and can be given contact details for NHS services, benefits, police, and so on.
Excerpted from The Social Worker's Guide to the Care Act 2014 by Pete Feldon. Copyright © 2017 Pete Feldon. Excerpted by permission of Critical Publishing Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
List of figures vii
Meet the author viii
Part I The care and support journey 5
1 First contact 7
2 Assessment of needs 21
3 Eligibility determination 49
4 The duty and power to meet needs 82
5 Charging and financial assessment 102
6 Care and support planning 122
7 Review 168
Part II Safeguarding 197
8 Safeguarding enquiries 199
9 Safeguarding - types of abuse, SABs and SARs 237
Part III Involvement - difficulties and disputes 245
10 Substantial difficulty in involvement 247
11 Disputes 266
Part IV Co-operating with partner organisations 269
12 Working with the NHS and housing 271
13 Modifications and additions for young people and prisoners 294
Conclusion: Implications for professional judgement 298