Contact and Referral Adult Care and Support Procedures (CMHT's)

1. Consent

Referrals

Referrals for adult Care and Support interventions cannot be taken unless:

1. The person or carer the referral relates to is making the referral;
2. The person or carer the referral relates to has given their consent to the referral; or
3. The person that the referral relates to lacks mental capacity to make a referral and a decision has been made under Best Interests that a referral should be made; or
4. The person that the referral relates to is at risk of harm from abuse or neglect.

Review

Requests for a review of an existing Care and Support/Support Plan can be made by anyone who has a concern that a plan may not be working as intended or a person's needs have changed. However, the person or carer whose plan it is must be consulted when deciding how to respond to the request, so it is important that wherever possible they know the request is being made from the outset.

2. Mental Capacity

If there are concerns that the person may lack capacity to consent to your support then a proportionate mental capacity assessment must be carried out to determine whether this is the case. This can be carried out anyone with the necessary skills to do so.

If the person has capacity to consent following the mental capacity assessment their consent must be obtained before support can be provided.

If the person lacks capacity to consent following the mental capacity assessment then a Best Interest Decision must be made to confirm that accessing the service will be in their Best Interests.

3. Legal Requirements of all Decision Making

The Care Act places certain duties on the Local Authority whenever it is making any decision about a person with (or who may have) Care and Support needs. These are things that you absolutely must consider and are:

1. The impact on the person's individual wellbeing;
2. Whether any other prevention service can be provided that will delay, reduce or prevent the need for Care and Support;
3. Whether information or advice can be provided to support the person to find their own solution, or to delay, reduce or prevent the need for Care and Support.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Promoting Individual Wellbeing for information about the duty to promote individual wellbeing;
• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice.

If the person is not happy with any decision that is made about them then you must make them aware of their right to complain about it.

4. A Strengths Based Approach

The Care Act statutory guidance states that, wherever possible, every conversation with a person should be from a strengths perspective. This means that before you talk about service solutions to any presenting issue you must support the person to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the person and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Area Co-ordination service intervenes with support, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

1. Taking a holistic view of the person or carers needs in the context of their wider support network;
2. Helping the person to understand their strengths and capabilities within the context of their situation;
3. Helping the person to understand and explore the support available to them in the community;
4. Helping the person to understand and explore the support available to them through other networks or services (e.g. health);
5. Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. See: Care Act guidance on Strengths-based approaches. Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

5. Providing General Information and Advice

The duty to provide good general information and advice about adult Care and Support applies at all times.

See: Providing Information and Advice to read more about the duty to provide information and advice, including how information and advice should be provided and the specific information and advice requirements around finances.

Local Information and Advice Resources

Online Resources

Bromley Council website

The Adult Social Care section of the Council's website includes information on the services available in Bromley.

See: Help for adults

Adult Care and Support Services Directory

The Adult Services Care and Support Directory (Your Guide to Independent Living) includes a range of useful information for the public on:

• Maintaining health and wellbeing and playing an active part in the community;
• Help to stay independent at home;
• Managing increasing health and support needs;
• Moving into supported housing, care homes, or nursing homes.

You can download the guide at the Bromley Council website.

Simply Connect Directory

The Simply Connect online directory supports residents to find local community services, activities, and support.

See: Simply Connect Bromley Website

Bromley Well

Bromley Well are commissioned by Bromley Council to provide a range of services to help people living in the Bromley borough to improve and maintain their health and wellbeing.

Bromley Well provide support for:

• Older people;
• Young carers;
• Adult carers;
• Mental health carers;
• Mutual carers;
• Learning difficulties;
• Physical disabilities;
• Mental wellbeing;
• Long term health conditions;
• Volunteering, training and paid employment.

Bromley Well offer a range of practical and emotional support, for the full range of available services please see the Bromley Well website.

The Bromley Well service is delivered by a partnership of local voluntary sector organisations called Bromley Third Sector Enterprise (BTSE) which brings together many years of expertise to provide a range of services for local people.

Bromley Third Sector Enterprise is made up of:

• Age UK Bromley & Greenwich;
• Bromley, Lewisham and Greenwich Mind;
• Bromley Mencap;
• Citizens Advice Bromley;
• Community Links Bromley;
• And a growing number of Associate Member organisations.

For more information about Bromley Well, or to make a referral, please see their website and contact details below:

Website: www.bromleywell.org.uk
Telephone: 0808 278 7898
Email: spa@bromleywell.org.uk

Citizens Advice

Citizens Advice provide free, confidential, and impartial advice, on a range of subjects, for example:

• Benefits;
• Work;
• Debt and money;
• Consumer;
• Housing;
• Family;
• Law and courts;
• Immigration;
• Health.

For more information about Citizens Advice, or to make a referral, please see their website and contact details below:

Website: Bromley Town Citizens Advice
Telephone: 0808 278 7898

Age UK

Age UK deliver a free, confidential, impartial information and advice service to older adults through telephone conversations, drop ins, appointments, and home visiting.

Some of the services Age UK provide include:

• Information & Advice;
• Befriending (home visits, telephone and groups);
• Footcare;
• Shopping Service;
• IT classes;
• Art classes;
• Seated exercise classes;
• Monthly walking groups.

For more information about Age UK, or to make a referral, please see their website and contact details below:

Website: Age UK (Bromley & Greenwich)
Telephone: 0208 315 1850
Email: info@ageukbandg.org.uk

Bromley Mencap

Bromley Mencap provide a wide range of information and support to disabled people, their parents and carers, in the London Borough of Bromley.

For more information about Bromley Mencap, or to make a referral, please see their website and contact details below:

Website: www.bromleymencap.org.uk
Telephone: 020 8466 0790

Deafplus Bromley

Bromley Council commission Deaf Plus to offer a wide range of services to individuals with hearing loss, to develop their potential and promote independence and wellbeing. Services include:

• Information and advice;
• Advocacy;
• The provision of equipment to aid independent living;
• Hearing loss support;
• Training.

For more information about Deaf Plus, or to make a referral, please see their website and contact details below:

Website: www.deafplus.org/advice
Telephone: 020 7790 8478
Email: info@deafplus.org

Kent Association for the Blind

Bromley Council commission Kent Association for the Blind (KAB) to hold the formal register for adults and children who are registered Sight Impaired (Partially Sighted) and Severely Sighted (Blind).

KAB provide a full rehabilitation service for adults with sight impairment to enable people to be as independent as possible. This service includes advice, support, equipment and training in mobility and daily living skills. Social clubs, assistive technology demonstrations and awareness training are also available.

For more information about KAB, or to make a referral, please see their website and contact details below:

Website: www.kab.org.uk
Simply Connect directory (for local KAB information)

Telephone: 0208 464 8406
Email: rehab.bromley@kab.org.uk
Address: Community House, South Street, Bromley, Kent, BR1 1RH, United Kingdom

Careplus

Careplus work with individuals, statutory and voluntary agencies to provide free local volunteer support for older people in the London Borough of Bromley to meet their needs for befriending, social support and practical assistance.

For more information about Careplus, or to make a referral, please see the website and contact details below:

Website: www.careplusbromley.org.uk
Telephone: 0793 095 5398

Benefits

Attendance Allowance helpline
Tel: 0345 605 6055
Email: attendance.allowanceenquiries@dwp.gsi.gov.uk

Personal Independence Payment (PIP) helpline
Telephone: 0345 850 3322

Benefits helpline (DWP)
Telephone: 0800 121 4600

Housing

Bromley Housing Options team provide advice and general assistance to anyone with a query or problem regarding housing issues or homelessness.

Website: www.bromley.gov.uk
Telephone: 0208 461 7721

Mental Health

For information about Bromley mental health services please see the Oxleas website.

Emergencies

In an emergency there is a 24-hour Mental Health Crisis Line: 0800 330 8590.

Adult mental health services

During normal working hours (Mon-Fri, 9am-5pm) you can telephone the Bromley Locality Mental Health Services:

Bromley West: Beckenham Beacon Hospital, First Floor, 379 Croydon Road BR3 3QL
Public Phone number: 020 8659 2151

Bromley East: Carlton Parade, Orpington, Kent, BR6 0JB
Public Phone number: 01689 892300

Older adult's mental health service

If you are a current service user you can contact the Community Mental Health Team (CMHT) Team at Bridgeways in Bromley on 0208 629 4900.

Change Grow Live (Bromley drug and alcohol service)

The Bromley Drug and Alcohol Service works in conjunction with Bromley Council's Adults and Community Services Department and local agencies to provide confidential help and advice to those with drug and solvent misuse related problems.

For more information about the Bromley drug and alcohol service, or to make a referral, please see their website and contact details below:

Website: changegrowlive.org/bromley-drug-alcohol-service
Telephone: 0208 289 1999

Bromley and Croydon Womens Aid (BCWA)

BCWA believe in providing high-quality services to anyone fleeing domestic abuse.

For more information about the BCWA, or to make a referral, please see their website and contact details below:

Website: www.bcwa.org.uk
Telephone: 0208 313 9303

National information and advice contacts

Sometimes it is helpful to contact a well known national organisation with a dedicated information and advice service or help-line. See: National Organisations with Information and Advice Helplines for details of some national organisations offering this service.

Some national organisations do not have dedicated information and advice services but can still provide such support upon request. See: National Contacts for Adult Care and Support for a wider range of useful national contacts for adult Care and Support.

You can also see the Financial Assessment and Charging FAQ Response Support Tool for the answers to some frequently asked questions around financial assessment, including questions relating to Disabled Facilities Grants.

Making Information and Advice Accessible

Information and advice must be provided in an accessible way so that the person for whom it is intended can best understand and make use of it.

If you feel the person for whom the information and advice is intended will need support to understand it then you should:

1. Consider whether the person has anyone appropriate who can help them to understand it;
2. Consider any steps that you can take to support them to understand it (for example talking through the information over the telephone or summarising it in a simpler format); and
3. Consider the benefit of independent advocacy.

Following Up on Information and Advice

Under the Care Act the Local Authority has a duty to not only provide information and advice where it is needed, but to ensure that the information and advice it provides has been effective.

Therefore, when information and advice has been provided you should agree appropriate arrangements to follow up with the person to whom it was given in order to review how effective it has been.

The timescales for this follow up should reflect the individual circumstances and level of risk.

Where you are making arrangements for someone else to follow up on the information and advice you have given (rather than following up on it yourself) you must make sure that you have recorded this in a way that will ensure the person follows up on it at the agreed time.

6. Accessing a Prevention Service

There are many kinds of prevention services available. Some are provided by the Local Authority and some are provided by:

• The community;
• Partner organisations, such as health;
• Private and voluntary organisations;
• Primary care.

All available prevention services in the local area should be explored before undertaking a longer-term intervention.

Under Section 2 of the Care Act the Local Authority has a duty to prevent needs for Care and Support/Support.

See: Preventing Needs for Care and Support to read more about the duty to prevent needs for Care and Support, including the types of prevention services recognised by the Care Act, when to provide prevention services and how to charge for prevention services.

There are descriptions below of some of the different prevention services utilised in Bromley and links to our webpages with more information on how these can be accessed.

Occupational Therapy Service

Bromley Council's Occupational Therapy service can help find solutions to keep people safe and independent in their own homes. The team consists of Occupational Therapists, Occupational Therapy Assistants and Moving and Handling Risk Assessors.

For more information, please see the Occupational Therapy webpages.

Reablement

The Reablement service provides intensive short-term support so people can relearn skills and regain their confidence to live independently.

For more information, please see the Reablement webpages.

Please see the Local Resources area for more information on referring to reablement.

Assistive Technology and Telecare

Assistive technology refers to Technologies (devices or systems) that maintain or improve independence or reduce risk to wellbeing.

Telecare is the term used to describe the range of equipment that can alert a call centre in a range of circumstances, e.g. if a person falls, leaves their home unexpectedly, or needs assistance. Bromley Carelink service is a 24-hour alarm scheme that helps vulnerable people to remain safely in their own home by enabling them to summon help in an emergency.

For more information, please see the Assistive Technology and Telecare Procedure, and the Carelink and Assistive Technology webpages.

Please see the Local Resources area for more information on setting up Assistive Technology and Telecare in Bromley.

Sensory Services

Deaf Plus

Bromley Council commission Deaf Plus to offer a wide range of services to individuals with hearing loss, to develop their potential and promote independence and wellbeing. Services include:

• Information and advice;
• Advocacy;
• The provision of equipment to aid independent living;
• Hearing loss support;
• Training.

For more information about Deaf Plus, or to make a referral, please see their website and contact details below:

Website: www.deafplus.org/advice
Tel: 020 7790 8478
Email: info@deafplus.org

Bromley Technical Officer for people who are deaf, deafened and hard of hearing

A range of assistive technology equipment is also available for people who are deaf, deafened, and hard of hearing from the Bromley Technical Officer, on loan and free of charge. This includes:

• Doorbell alert;
• Personal amplifier;
• Alarm clocks;
• Baby monitor;
• Smoke alarms.

Referrals should be made via the Initial Contact Team.

Kent Association for the Blind

Bromley Council commission Kent Association for the Blind (KAB) to hold the formal register for adults and children who are registered Sight Impaired (Partially Sighted) and Severely Sighted (Blind).

KAB provide a full rehabilitation service for adults with sight impairment to enable people to be as independent as possible. This service includes advice, support, equipment and training in mobility and daily living skills. Social clubs, assistive technology demonstrations and awareness training are also available.

For more information about KAB, or to make a referral, please see their website and contact details below:

KAB website: www.kab.org.uk
Simply Connect directory (for local KAB information): bromley.simplyconnect.uk

Tel: 0208 464 8406
Email: rehab.bromley@kab.org.uk
Address: Community House, South Street, Bromley, Kent, BR1 1RH, United Kingdom

7. Raising a Safeguarding Concern

If, as part of any conversation or information gathering you become concerned that a vulnerable adult or child is experiencing, or at risk of abuse or neglect you must respond appropriately by raising a concern.

See Safeguarding Adults, which also includes information about how to raise a children's safeguarding concern.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

8. Using Independent Advocacy

The Advocacy Duty

Whenever the outcome of a contact or referral is that the person will be involved in any adult Care and Support process (including any assessment, or safeguarding) the Local Authority has a duty under the Care Act to make an independent advocate available to the person when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the person would experience substantial difficulty being fully involved in the Care and Support process without support.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool.

The Local Authority also has a power (but not a duty) to make advocacy available in other situations on a case by case basis if it deems this appropriate and is able to do so. This could include advocacy to support a person to understand information and advice, or advocacy to support a person to explore possible options available to them.

The Difference between substantial difficulty and lacking mental capacity

Having substantial difficulty is not the same as lacking mental capacity.

See: Determining Substantial Difficulty for information about how to determine substantial difficulty.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing capacity and making best interest decisions.

An appropriate person

An appropriate person for general representation purposes is not the same as an appropriate person for independent advocacy under the Care Act.

See: An Appropriate Other Person for information about the difference and how to establish whether there is already an appropriate person.

The role of the Independent Advocate

The role of an independent advocate appointed under the Care Act is not the same as the role of a general advocate or any other type of advocate (for example an Independent Mental Capacity Advocate or an Independent Mental Health Advocate).

An independent advocate appointed under the Care Act must both facilitate and ensure the involvement of the person with substantial difficulty in the Care and Support process that is taking place.

For information about the ways in which an independent advocate should fulfil their role, see: The Role of an Independent Advocate.

Advocacy for people who lack Capacity

People who lack capacity will likely be legally entitled to advocacy under both the Care Act and the Mental Capacity Act 2005.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or whether any important decisions are likely to be the outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool.

Advocacy for people subject to the Mental Health Act

People eligible for an Independent Mental Health Advocate (IMHA) under the Mental Health Act 1983 will likely be entitled to advocacy under the Care Act.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or the likely outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool.

Making a Referral for Independent Advocacy

The advocacy referral can be made at any time and should be made without delay as soon as the duty applies.

Guidance and a referral form are available on the Advocacy for All (the current provider's) website.

See: Advocacy for All

What to do if Independent Advocacy is not available or delayed

Regardless of whether or not independent advocacy is available in the local area the duty to provide it still applies. A failure to do so is a breach of this duty and of the law. It is the role of commissioners to ensure that advocacy services are in place and available when required, and it is the role of practitioners to make timely referrals to advocates to prevent unnecessary delays in the meeting of its duty.

If you are aware that advocacy support is required and is not yet available you must not proceed to carry out any Care and Support process until it is in place.

In some circumstances urgent interim measures may need to be agreed without an advocate in place in order to reduce immediate risk to the person from inaction. However, Care and Support processes that will decide long term and important decisions must not be carried out without advocacy support.

What to do if the person does not want to use advocacy

The duty upon the Local Authority is to make independent advocacy support available to any person who requires it. Once made available the duty is met.

If a person decides that they do not wish to engage in the advocacy support that has been made available to them they do not have to do so, but the Local Authority must still provide it.

The Local Authority is expected under the Care Act to support the person to understand the role of an advocate and promote its benefit to them so as to reduce the likelihood that they will not engage.

9. Gathering Information and Consulting with Others

The purpose of gathering information and consulting

The purpose of consultation and information gathering is to ensure that the response of the Local Authority is a proportionate and appropriate one to the person's situation and level of need. Only information relevant to this purpose should be gathered during consultation.

All information gathering should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

Methods of consultation

The method of consultation and information gathering used should reflect the individual circumstances of the case. Depending on the level of urgency, risk and need consultation and information gathering can be formal or informal in nature.

For example:

1. A telephone conversation;
2. An email or letter; or
3. A face to face meeting.

Where the method of consultation is not face to face you should be satisfied that the information you share will only be seen by the person for whom it is intended.

Where the Person has requested the Local Authority Gather Information or Consult

The Care Act is clear: Apart from cases where the level of risk is paramount you must consult with anyone that the person has asked you to consult with before making any outcome decision.

Examples of paramount risk could include:

1. Where urgent action is required, that if delayed to allow consultation would place the person at imminent risk of abuse or neglect leading to serious harm;
2. Where the person to be consulted is deemed to be the perpetrator of abuse and neglect and consulting with them at that time would place the person (or another vulnerable adult or child) at imminent risk leading to serious harm;
3. Where urgent Care and Support provision is required, that if delayed to allow consultation would place the person at imminent risk of harm through the non-meeting of essential needs.

The person should be told why consultation has not occurred, and long term decision making should be avoided until such time when consultation is possible.

Consulting with carers

Where the person is known to have a carer the Care Act expects you to consult with them before making any decision regarding Care and Support for the person.

The purpose of doing so is:

1. To gather information about the support they provide to the person; and
2. To understand the needs of the carer and fulfil the duty to meet them.

Where the person with Care and Support needs does not consent to you consulting with their carer you should explain to them that you must still do so for the purposes above. However, the consultation should be limited to that purpose and other information about the circumstances of the person should not be shared or discussed.

Consulting with Others

You should proactively identify anybody else that it may be appropriate to speak with in order to gather comprehensive information upon which to decide the most appropriate outcome. This could be a family member, a health professional, another Local Authority or an organisation (such as a Care and Support provider).

With the consent of the person the Local Authority is permitted under the Care Act to consult with anybody it deems it relevant to consult with, and anybody contacted by the Local Authority has a duty to co-operate with requests for information or support.

See: Co-Operation to read more about the duty to co-operate under the Care Act.

Consent to Consult and Mental Capacity

If there are concerns that the person may lack capacity to consent to you gathering information from or consulting with others then a mental capacity assessment must be carried out to determine whether this is the case. This should be carried out by the Local Authority because it is the Local Authority who wishes to consult.

If the person has capacity to consent following the mental capacity assessment their consent must be obtained before consulting others.

If the person lacks capacity to consent following the mental capacity assessment then a Best Interest Decision must be made to confirm that consulting with others will be in their Best Interests. This decision should be made by the Local Authority because it is they who will be consulting.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing capacity and making best interest decisions.

10. Providing Information about a Person

The Local Authority has a common law and legal duty to safeguard the confidentiality of all personal information.

As an employee of the Local Authority you are bound contractually to respect the confidentiality of any information that you may come into contact with. Under no circumstances should such information be divulged or passed to any persons or organisation in any form unless you have authorisation to do so.

All information sharing that takes place must be in line with data protection legislation (namely the UK General Data Protection Regulation and the Data Protection Act 2018) and local policy.

The Caldicott Principles must also be regarded. The Caldicott Principles are a set of principles that apply to the use of confidential information within health and social care organisations and when such information is shared with other organisations and between individuals, both for individual care and for other purposes. For further information, see: The Caldicott Principles.

Any unauthorised disclosure of confidential information may result in disciplinary action of individual prosecution under the Data Protection Act 2018.

For further information and guidance, see: Providing Information about a Person or Carer.

11. Acting on Information about Risk

Information that a person may be at risk

If you have received information that indicates a person may be at risk of abuse or neglect you will need to consider the measures that you (or others) can take to protect them.

Where a safeguarding concern has not been raised already you should raise a concern without delay.

See Safeguarding Adults.

Information that a person may be risky

If you have received information that indicates that a person may pose a risk to others you will need to consider the measures that you (or others) can take to reduce the risk and protect others.

See: Risk Assessment.

If the risk assessment indicates that a vulnerable adult or child may be at risk of abuse and neglect you must ensure that you raise a safeguarding concern without delay.

See Safeguarding Adults, which also includes information about how to raise a children's safeguarding concern.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

12. Urgent or Interim Support

When urgent or interim support can be provided

Not everyone contacts the Local Authority in a timely way so as to allow for an assessment and exploration of options to take place prior to any initial decisions being made about the need for Care and Support.

For example, some people only approach the Local Authority when they are in a time of crisis, high risk or when there is a sudden or unexpected change in their Wellbeing.

In these cases there may appear to be an urgent need for support that cannot wait for an assessment or review process to be carried out.

The Care Act recognises this occurrence and gives the Local Authority powers to meet such needs without having carried out a formal assessment process.

To see what the Care Act says about meeting urgent needs without an assessment or review, see: The Power to Meet Needs.

Having the power to meet needs without an assessment or review means that the Local Authority can decide whether or not to do so, based on the available information and specific circumstances of the person and their situation.

Deciding how to meet interim needs

Under the Care Act, the Local Authority can put any interim or urgent measures in place that it deems appropriate to meet the needs of the person and manage the situation. This can range from a small number of domiciliary care visits to a stay in residential accommodation.

The same legal considerations apply when meeting urgent needs as they do when meeting non-urgent needs:

1. The impact on the person's individual wellbeing;
2. Whether any preventative service can be provided that will delay, reduce or prevent the need for Care and Support;
3. Whether information and advice can be provided to support the person to find their own solution, or to delay, reduce or prevent the need for Care and Support.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Promoting Individual Wellbeing for information about the duty to promote individual wellbeing;
• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice.

In addition, you should be mindful that nobody has yet assessed (or reassessed) the needs of the person and you may be relying on historical information or information from sources currently under significant strain or pressure to act. As such the information presented may or may not be an accurate reflection of the person's needs following an assessment.

Interim support should therefore only be seen as a temporary measure to reduce risk of harm and support the person to a place in time where a needs assessment can be carried out and long term options explored and agreed with them. As such, you should be cautious about providing interim Care and Support that may be problematic to cease following assessment.

tri.x has developed a tool that can be used as required to support consistent decision making about the provision of urgent or interim support.

See: Urgent or Interim Support Decision Tool.

Requesting Funding for Urgent or Interim Support

All funding requests for urgent and interim support should be made in line with local processes and requirements.

Funding Decisions for Urgent or Interim Support

It can be difficult to make a decision about the level of funding required to meet the urgent or interim Care and Support needs because:

1. There will be no personal budget allocated to the person; or
2. There will be a personal budget but this will not be based on their current needs.

The Care Act does not discuss or set funding limitations in relation to the provision of any Care and Support. This includes urgent and interim Care and Support. Instead, the golden rule of the Care Act when making any funding decision is that 'the amount of funding agreed must be sufficient to meet the needs that are to be met at that time'. Decisions must also be made in a way to ensure that the person will be satisfied the process was fair and robust.

Other than sufficiency, the factors that decision makers must consider are:

1. The views and wishes of the person about how their needs should be met;
2. The availability of other potential options in the marketplace; and
3. The cost of available suitable services in the marketplace.

Other factors that should be considered are:

1. The complexity of the person's needs;
2. The level of risk/sense of urgency; and
3. Whether the practitioner requesting the funding has provided relevant information and advice, whether they have explored prevention services that may be appropriate and whether they have explored how the person's own networks of support could help; and
4. Where the person is not ordinarily resident; if they receive Care and Support already in another Authority the nature of the Care and Support they receive.

Decision makers should also take into account that the Local Authority is also permitted under the Care Act to consider how to balance its legal requirement to maintain universal services to the entire local population with the power to meet urgent needs. In doing so it must:

1. Not base it's decision on finances alone;
2. Consider things on a case-by-case basis; and
3. Not set arbitrary limits (fixed amounts for a particular type of need or service).

Communicating the outcome

The outcome of the funding decision should be communicated to the person at the earliest opportunity. The method of communication should reflect that requested by the person and any specific communication needs they may have. For the purposes of the Care Act communication about the outcome of a funding decision is subject to the same requirements as the provision of information and advice, and the duty to make it accessible therefore applies equally.

Where communication is provided by telephone a follow up letter confirming the conversation and the funding decision should be sent to the person as a formal record.

When communicating the outcome you should include the following information:

1. The funding decision itself;
2. The rationale for the decision;
3. Any information and advice relating to adult Care and Support, and the prevention, delay or reduction of needs;
4. What will happen next and the timeframes involved;
5. How to complain about any aspect of the decision or proposed outcome.

Recording Urgent and Interim Support

Any funding decision rationale should be clearly recorded in line with local recording requirements.

The Local Authority is not required to record urgent and interim support on a Care and Support Plan because:

1. The support is being provided under the Local Authority's powers (as opposed to duties);
2. The person has not yet been assessed (or reassessed); and
3. There has been no decision about eligible needs.

However, the following must be clearly recorded:

1. The urgent or interim support being provided;
2. The contribution to the cost of the support being made by the Local Authority;
3. The contribution being made by the person;
4. The duration of the support;
5. How the support will be reviewed;
6. What outcomes the support aims to achieve; and
7. The next steps, including timeframes for any assessment.

Arranging Interim or Urgent Support

Under the Care Act the process of arranging to meet urgent and interim Care and Support needs is the same as arranging to meet needs agreed through a non-urgent Care and Support Planning process.

Charging for Care and Support

The Local Authority is permitted under the Care Act to charge any person for Care and Support (including Care and Support provided on an urgent basis) unless:

1. It chooses not to; or
2. The person has been financially assessed as having insufficient funds to contribute; or
3. The support being provided is reablement (up to 6 weeks is non-chargeable); or
4. The support being provided is equipment (up to the cost of £1000 is non-chargeable).

For further information about charging for all services under the Care Act, see: Power of the Local Authority to Charge.

See the Financial Assessment Procedure for further guidance.

Urgent Support for people who are not ordinarily resident

Where urgent support is provided to a person who is not ordinarily resident contact should be made at the earliest opportunity to the Local Authority in which they live to inform them of the intention to meet an urgent need.

Where the person is already in support of a service from the other Local Authority information should be gathered to support any decisions made about which support should be provided.

Agreement should be reached with the other Local Authority about how any urgent Care and Support services will be monitored, when they intend to assess for eligible needs and how reimbursement of costs incurred can be sought.

tri.x has developed a tool to support decision making around ordinary residence.

See: Ordinary Residence Decision Support Tool.

Also see the Ordinary Residence Procedure for further information.

13. Revising a Care and Support Plan

When a Care and Support Plan can be revised

Under the Care Act, when a person is already receiving Care and Support from the Local Authority they may request a change to their Care and Support Plan at any time and the Local Authority must consider the request. Where the request is deemed reasonable the Local Authority has a duty to review the plan.

The review is the mechanism by which the need for a revision is determined. As such, under the Care Act a Care and Support Plan can only be revised following a review.

Where a change is requested to a plan and there is no planned review scheduled consideration should be given to arranging an unplanned review. Any review must be proportionate to the needs of the person and undertaken in a timely way so as to reduce the risk of a crisis developing and needs not being met.

When there is an allocated worker

If the person has an allocated worker this person should carry out the review, unless the review is urgent and the worker is unavailable.

Before transferring the review request you should confirm that the practitioner the review request is being transferred to is available.

If the practitioner is not available you should speak with a manager to establish whether:

1. The request should still be transferred to the allocated worker to action when they become available;
2. Alternative arrangements should be made to carry out the review.

If there is no allocated worker

Where the information gathered at contact suggests there has been no change in the person's needs, and that a change to the personal budget amount is not required may be possible to complete a 'light touch' review without further allocation.

When the information gathered at contact suggests there has been a change in need or circumstance, and that a change in the personal budget amount is required any review carried out is likely to lead to a proportionate reassessment of need. Because this is a longer term intervention allocation for this should be considered.

14. Transferring a Contact

It is important that the person making contact speaks to the right practitioner at the right time. Sometimes you may find that you are not the most appropriate practitioner to manage the contact.

Transferring a telephone contact

When the person making the contact requests specifically to speak to or be contacted by a particular person you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the person is allocated to the practitioner they have requested to speak to.

You should not transfer a telephone call to a named worker if it is clear that the worker is not allocated to the person. This will not be helpful to the worker or to the person as they will not be speaking to the right person to resolve the contact.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If you know when the practitioner is likely to become available you should:

1. Inform the person of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and confirming the information given to the person about when to expect a call back;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required should the practitioner be unavailable for more than a few hours;
4. Agree with the person what they should do if the practitioner does not make contact at the expected time; and
5. Make a proportionate record of all the above.

If it is not clear when the practitioner will become available you should:

1. Inform the person of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and what information has been given to the person;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required; and
4. Agree with the person what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

Transferring a written, e-mail or text contact

When a written contact is addressed to a named worker you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the person is allocated to the practitioner they have addressed the written contact to.

You should not transfer a written contact to a named worker if it is clear that the worker is not allocated to the person. This will not be helpful to the worker or to the person as they will not be dealing with the right person to resolve the contact.

Before transferring the contact you should:

1. Confirm that the practitioner the written communication is being transferred to is available within a reasonable timeframe for the action indicated by the contact, or that you have agreed with a manager how the contact will be managed;
2. Where the communication is a letter or an e-mail, whether the practitioner wishes to receive the original contact (if not this should be filed securely); and
3. Where a written response confirming the contact has been received is required or requested, agree who will provide this.

The most secure way to transfer a written contact is to send a message to the practitioner alerting them to the contact and where it can be found on the recording system.

Any original copies of e-mails must be sent via internal secure e-mail systems only and any original letters must be sent via internal postal services or secure delivery only.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If the practitioner is not available within a reasonable timeframe for the action indicated by the contact you should:

1. Leave the practitioner a message alerting them to the contact, where it can be found on the recording system and any action undertaken, including what has been agreed with the person if contact has been made with them;
2. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required and writing any acknowledgement letter to confirm arrival of the contact;
3. When the practitioner is not available within any timeframes indicted in the written contact or for more than a few days inform the person making the contact of this;
4. Agree with the person what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

15. Joint Work

Sometimes there may be a clear benefit to a joint assessment or intervention with another service area. The Care Act recognises this and permits the Local Authority to make any arrangements it deems appropriate in order to facilitate joint working with others.

The duty to co-operate

Where the Local Authority requests another party to work jointly in some way to benefit the person with Care and Support needs that party has a duty to co-operate with the request (unless by doing so they will be prevented from carrying out their own duties under the Care Act or other legislation).

For further information about the duty to co-operate under the Care Act, see: Co-Operation.

How to request joint work or assessment

Any decision to request joint work should be made with the person (or their representative). Where the person is unable to provide consent to joint work decisions should be made in their best interests.

Joint work requests should be made in the manner preferred by the service to which the request is being made. This may or may not take the form of a referral.

The request should explain clearly the nature of the joint work required and any specific skills, knowledge and competence requirements to support allocation.

Responding to a request for joint work

When you have been asked to work jointly with another service you should contact them to confirm your involvement and discuss the most effective way to work together. The things you should establish include:

1. The work they are doing/will be doing/have done and whether they have any information that you need to know or can use to avoid duplication;
2. Whether there are opportunities to co-ordinate systems and processes and, if so how this will be managed;
3. What the expectations are in terms of joint-working (for example will you be expected to carry out a joint assessment, meet with the person together, produce joint records or just consult and share information);
4. What the anticipated outcome of the joint work is (for example joint funding of support, on-going joint-work to monitor);
5. What does the person with care and support needs know about the joint-work to be carried out (and if they don't know who and how should this be explained);
6. Who will be the primary contact for the person (or their representative) to go to with any queries; and
7. Who will be responsible for communicating progress and decisions to the person.

See: Joint Work for further practice guidance about effective joint working.

If there are likely to be delays in your commencement of joint work the person who requested the joint work will need to:

1. Consider whether to proceed with their intervention; or
2. Await your availability.

It is the responsibility of the person requesting joint work to make this decision (in agreement with the person and any carer) and to take steps to ensure that any urgent needs for Care and Support are met.

Specialist joint work or assessment

Some areas of joint work are specialist or non-frequent in nature. The procedures for these pieces of work can be found in the Specialist and Universal Procedures section of this manual. The following are examples of the procedures that can be found there:

1. NHS Continuing Healthcare;
2. Continuity of Care;
3. Cross Border Placements.

17. Recording Decision Making

Recording of decision making should be clear and comprehensive yet proportionate. Anyone reading the recordings should be able to (as quickly and easily as possible) understand what has happened and why a particular decision has been made.

When available it is important to capture in recordings:

1. The views of the person with Care and Support needs in regard to;
   • Their needs and what they would/would not like to happen;
   • The information and advice that has been given to them;
   • Any verbal consent given to gather information or consult with others; and
   • The possible outcomes that have been explored with them.
2. The views of any carer in regard to;
   • The needs of the person;
   • Their needs and what they would/would not like to happen;
   • The information and advice that has been given to them;
   • Any verbal consent given to gather information or consult with others; and
   • The possible outcomes that have been explored with them.
3. The details of and views of any other person or organisation consulted with as part of the decision making process;
4. Details of any manager or peer supervision discussions that have influenced the outcome decision;
5. Any actions agreed with anyone, including how any follow up will take place;
6. Where there have been concerns about the person's mental capacity to consent to the contact or referral, to consent to consultation with others or to be part of the decision making; a record of how mental capacity has been assessed and how any best interest decisions have been made;
7. How the outcome has been decided, particularly how regard has been shown for individual Wellbeing, and how the decision prevents, delays or reduces the needs for Care and Support;
8. How the outcome has been communicated and how it was received; and
9. How the situation will be monitored for changes.

Recording should take place as near to the time that the actual event being recorded took place and in line with local recording requirements.