Communicating the Outcome and Next Steps (Occupational Therapy)

1. In all Cases

Having made a determination about eligibility, the Care Act requires that in all cases you must give the person (or their representative if they lack capacity) a written record, explaining:

1. The overall eligibility determination (whether or not the person's overall needs meet the eligibility criteria as set out under the Care Act); and
2. The rational for the decision.

It is important that the person understands the eligibility outcome and the reasons for it. To this end it should be provided in a format that is accessible to them.

If the outcome has been provided in a format that you know or suspect the person will not be able to understand you should:

1. Consider any steps that you can take to support them to understand it (for example talking through the outcome over the telephone or summarising it in a simpler format); and
2. Consider the duty to make an independent advocate available.

2. When the Overall Determination is 'Ineligible'

When needs are ineligible

The overall eligibility determination is 'ineligible' when one of the following applies:

1. None of the person's needs arise, or are the result of a physical or mental impairment; or
2. The needs do not prevent the person from achieving 2 or more of the listed outcomes; or
3. The impact on Wellbeing of not being able to achieve any of the outcomes is not significant.

Where the overall eligibility determination is 'ineligible' there is no duty on the Local Authority to meet any needs that the person has.

Communicating the Outcome

When providing the written record of the ineligible determination you must:

1. Explain the eligibility determination;
2. Explain the rationale for the determination;
3. Provide written information and advice about what can be done now to reduce the ineligible needs that the person has; and
4. Provide written information and advice about what can be done to prevent or delay the development of eligible needs.

Click here to access the procedures for providing information and advice, including links to local and national resources.

Click here to access the procedures for preventing, delaying or reducing needs for Care and Support.

You should also consider:

1. Any need for action under adult safeguarding procedures (for example, if the person is self neglecting or unable to protect themselves from abuse or neglect from others); and
2. Any need for action under children's safeguarding procedures (if a child is living in destitution they are a 'child in need' under the Children Act 1989).

Meeting Ineligible Needs

Under the Care Act the Local Authority has a power to meet needs that have not been deemed eligible, normally under the remit of preventing a crisis or longer term needs through a short term intervention. However, this power should not be used routinely or without authority and you should familiarise yourself with the local policy for meeting ineligible needs.

3. Meet Needs under other Provisions

Where the outcome of the eligibility determination is 'ineligible' and the outcome is likely to have a detrimental impact on the prevention, reduction or delay of needs you should discuss this with your line manager.

In particular consideration should be given as to whether:

1. It is possible and appropriate to provide any equipment under the duty to prevent, reduce or delay needs; or
2. It is possible and appropriate to provide any minor adaptations under the duty to prevent, reduce or delay needs; or
3. It is possible and appropriate to explore providing the adaptation under the HGCRA (if so the HGCRA criteria will need to be applied).

Both the Care Act and the HGCRA do not specify which adaptations must/can be provided by which legislation, only which needs are eligible. This is very much determined locally and, before you have any conversations with the person (or carer) about the possibility of meeting needs through other means you must familiarise yourself with local policy about:

1. The specific equipment and adaptations that the Local Authority will provide as part of the duty to prevent, reduce and delay needs;
2. The specific equipment and adaptations that the Local Authority will provide under the Care Act;
3. The specific adaptations that the Local Authority will provide under the HGCRA;
4. Any financial 'cut-off' points below which the Local Authority will not consider carrying out adaptations under the HGCRA; and
5. Any financial 'cut-off' points above which the Local Authority will not consider carrying out adaptations under the Care Act.

4. When the Overall Determination is 'Eligible'

The overall eligibility determination is 'eligible' when:

1. The person's needs arise from, or are the result of a physical or mental impairment or illness; and
2. Because of their needs the person is unable to achieve any 2 or more of the needs-related outcomes; and
3. The impact on Wellbeing of not being able to achieve the outcomes is significant.

When providing the written record of the determination you must:

1. Explain the eligibility determination;
2. Explain the rationale for the determination;
3. Where there are both eligible and ineligible needs, provide written information and advice about what can be done now to reduce any ineligible needs that the person has; and
4. Where there are both eligible and ineligible needs, provide written information and advice about what can be done to prevent or delay the development of eligible needs.

5. Managing Disagreement about Eligibility

Under the Care Act the Local Authority is responsible for applying the criteria and making the final decision about eligibility. As such this is your responsibility as you are the Local Authority's representative.

There may be times when the person, their representative or another person disagrees with the eligibility determination you have made.

In this situation you should be open to reviewing the available evidence and your rationale to ensure that the determination you have made is robust. You should be open and transparent about the evidence sources you have used and take steps to try and support the person to understand the determination you have made.

Where ongoing disagreement persists you should:

1. Seek the support and advice of your line manager as required;
2. Make a record of any difference of opinion in the formal record of assessment;
3. Ensure the evidence upon which you have based your decision is robust;
4. Make sure that the regard you have given to the views of the person (and others) and the impact on their Wellbeing is clear; and
5. Make proportionate records of any conversations you have had to try and resolve the differences.

You must also make the person (or their representative) aware of their right to complain about the decision that has been made.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Click here to read the complaints policy and procedure.

6. When Occupational Therapy is not Appropriate

Notifying the person

The decision not to provide services to meet needs through Occupational Therapy should not be something that is discussed for the first time at the point that eligibility is determined, although this is likely the point where the decision will be confirmed.

The decision should give regard to:

1. The views of the person about the appropriateness of Occupational Therapy;
2. The views of any carer; and
3. The impact of the decision on the person's Wellbeing.

When a decision is made not to meet needs through Occupational Therapy the following information should be confirmed in writing to the person:

1. That Occupational Therapy is not going to be provided;
2. The rationale for the decision;
3. What steps the person can take should their needs change in the future and further assessment is required.

You must also make the person (or their representative) aware of their right to complain about the decision that has been made.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Click here to read the complaints policy and procedure.

Ensuring eligible needs are met

Where the assessment has identified that the person has eligible needs that it is not appropriate to meet through Occupational Therapy services you must:

1. Establish whether the person has a Care and Support Plan; and
2. Establish whether the Care and Support Plan is meeting those needs.

Under no circumstances must you ignore on-going needs or close the case. The Local Authority has a duty to determine the eligibility of assessed needs and to meet eligible needs and is in a breach of the Care Act if it fails to do so.

Where the person has a Care and Support Plan

If the person has a Care and Support Plan that is meeting all needs there is no further action required.

If the person has a Care and Support Plan that does not appear to be meeting the entire person's needs a review of the plan should be requested. You should inform the person and seek their consent to make the review request, although even if the person does not consent you should still make the request. This is because:

1. The consent of the person is not required to request the review (only to carry it out); and
2. If you are aware that the Care and Support Plan is not fulfilling the statutory duty to meet eligible needs you have a duty to request the review.

The review request should be made to either:

1. The allocated practitioner with responsibility to review the plan; or
2. The team or service with responsibility to review the plan.

When requesting the review you should provide the following information:

1. Why the review is being requested and the sense of urgency;
2. Whether the person has consented to the review;
3. The information gathered during the assessment to support the request;
4. The on-going role of the Occupational Therapy service (if Occupational Therapy is to be provided in relation to other needs); and
5. Whether there is a need to provide urgent or interim support.

You should therefore explain to the person (and any carer) that:

1. You have requested the Care and Support plan is reviewed; and
2. That the person/service with responsibility for carrying out the review will be in contact with them to discuss carrying out the review.

Where the person does not have a Care and Support Plan

If the person does not have a Care and Support Plan you will need to agree with the person what steps need to be taken to ensure that their eligible needs are met.

If a practitioner from an appropriate service is already involved with the person you should:

1. Notify them that an assessment has been carried out, the outcome of the assessment and the rationale; and
2. Provide them with access to the information gathered during the assessment so they can prioritise and consider the most appropriate course of action.

If the person is not known to an appropriate service you will need to support the person to make a referral to Croydon Adult Support.

Closing the case

You can proceed to close the case when:

1. There are no outstanding actions for the Occupational Therapy service following the assessment;
2. The person has been provided with all information and advice required (or that would be beneficial);
3. Steps have been taken to ensure that any eligible on-going needs for Care and Support will be met in a timely way (either through urgent/interim services or through Care and Support planning).

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship;
2. Deputyship;
3. Carers support;
4. Tenancy in extra sheltered housing.

Click here to access the process for ending your involvement and closing a case.

7. Next Steps (when Occupational Therapy is Appropriate)

Under the Care Act there are 3 steps that you must carry out when:

1. A determination of eligible need has been made;
2. The person has been notified of outcome; and
3. Occupational Therapy is deemed an appropriate service to meet eligible needs (either all needs or some needs).

These steps should be carried out prior to arranging for the provision of equipment or adaptation to meet needs.

Under each step you should ensure appropriate and proportionate recording to evidence:

1. What has been explored or discussed;
2. What has been agreed;
3. The rationale/evidence for any agreement or decision (including the regard that has been given to the thoughts, wishes and feelings of the person); and
4. Further action required (including any mechanism to monitor or review decisions made).

Where the person lacks capacity

If the person with Care and Support needs lacks capacity to engage in the 3 following steps you should discuss options with their representative and decisions should be made in their best interests.

Click here to access the Mental Capacity Act 2005 Resource and Practice Toolkit, which contains guidance about assessing capacity and making best interest decisions.

Step 1: To consider with the person what can be done to meet the eligible needs they have

The primary purpose of step 1 is to establish the range of ways that the person could meet their eligible needs, beginning with ways that needs could be met from within their own available resources (for example independently, by a carer or within the local community). This is called a strengths based approach and, wherever possible, every conversation with a person about meeting needs should be from a strengths perspective. This means that before you talk about service solutions to the 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.

Where there appears to be limited or inappropriate options to meet one or more eligible need from within the person's own networks you will need to provide information about the nature of available services that the Local Authority could provide to meet needs.

Step 2: Establish whether the person wants the Local Authority to meet their eligible needs

Step 1 will have identified a range of possible options to meet the eligible needs that the person has.

The person will need to decide (or, if they lack capacity a decision will need to be made in their best interests):

1. Whether they want Occupational Therapy to arrange equipment or adaptations to meet their needs;
2. Whether they want to arrange their own equipment or adaptations (in which case they will need to be given good information and advice about the equipment and adaptations required so as to make appropriate arrangements); or
3. Whether they want to access alternative provision (for example health, housing or a community based provision).

Whether or not the person wants the Local Authority to meet their eligible needs will depend on a range of factors, and could include:

1. The complexity of their need, including any fluctuation in need and the need for multiple Care and Support services;
2. The person's ability to make and sustain alternative arrangements;
3. The availability and sustainability of informal support options (e.g. carers and other informal networks);
4. The availability of alternative support and services in the area (for example, a housing service that could meet the need may be available but have a long waiting list);
5. The level of risk in their current situation, including the risk of abuse and neglect;
6. The financial implications of services for the person; and
7. The level of on-going support likely to review and monitor the person's needs or situation.

Alternative solutions to Local Authority services

Sometimes the person will decide to arrange their own equipment or adaptation, for example:

1. If they have a preferred piece of equipment that the Local Authority is likely to deem disproportionate to the level of need to be met; or
2. The person intends to access a housing prevention service to carry out an adaptation that the Local Authority is not able to carry out under the Care Act.

You must be satisfied that the person (or their representative) understands that:

1. They are under no obligation to do so; and
2. The Local Authority must provide equipment free of charge up to £1000.

Where the person decides to make arrangements outside of the Local Authority to duty to meet eligible needs still applies until such time when the need is appropriately met. This means you will need to consider:

1. Information and advice required to ensure that any equipment or adaptation that the person arranges will meet their eligible needs; and
2. Supporting the person to access an appropriate provider;
3. The need to provide short term equipment; and
4. Monitoring the situation to ensure that eligible needs are being met as intended.

Closing the case

You can proceed to close the case when:

1. There are no outstanding actions for the Occupational Therapy service;
2. The person has been provided with all information and advice required (or that would be beneficial);
3. There is no need to monitor whether eligible needs are being met.

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship;
2. Deputyship;
3. Carers support;
4. Tenancy in extra sheltered housing.

Click here to access the process for ending your involvement and closing a case.

Step 3: If the person wants the Local Authority to meet their needs, establish whether they are Ordinarily Resident in the Local Authority area.

This is the stage when ordinary residence should be established under the Care Act. Following a determination of eligibility the Local Authority can only meet the eligible needs of a person if they are:

1. Ordinarily resident in their area; or
2. Present in the area and of no settled residence.

Click here to read what the Care Act says about ordinary residence, including understanding what ordinary residence is, how/when to establish ordinary residence and how/when to meet the needs of people who are not ordinarily resident in the area.

Click here to access a tri.x tool to support decision making around ordinary residence.

Click here to see the ordinary residence procedures, which include how to seek reimbursement for urgent needs met and any supporting documentation.

If you are at all unclear about the ordinary residence of the person after accessing the available information in these procedures you should speak to your line manager.

8. When the Local Authority must meet Eligible Needs

When the Local Authority must meet needs

The Local Authority must meet needs whenever:

1. The person has eligible needs that have been determined through an assessment; and
2. The person is ordinarily resident in the Local Authority area (or present with no settled residence); and
3. The person has confirmed (through the steps above) that they want the Local Authority to meet their needs; or
4. The person lacks capacity to decide who should meet their needs and the Local Authority makes a best interest decision to this effect.

When the Local Authority may meet needs

If the person advises that they will be arranging their own equipment or adaptations to meet needs and they have capacity to do so there is no duty for the Local Authority to do so. However, you should always consider whether there would be a benefit in arranging equipment and services when:

1. The person has complex needs and consents to the Local Authority arranging the equipment or adaptation; or
2. There are other circumstances in which you feel arranging the equipment or adaptation would be beneficial and the person consents.

When the Local Authority should not meet needs

The Local Authority should not arrange to meet needs through equipment when:

1. The person does not have eligible needs under the Care Act; and
2. The Local Authority does not intend to meet ineligible needs; or
3. The person has capacity and has informed the Local Authority that they will be making their own arrangements to meet needs.

If the person decides to make their own arrangements you must:

1. Provide them with the information and advice they request (or you feel would be beneficial) about available appropriate equipment and local services/suppliers to meet their needs;
2. Provide them with information and advice about ways they can prevent, reduce or delay needs;
3. Provide them with any other information that they request or that you feel will be beneficial;
4. Consider the support the person may need to explore and make their own arrangements and whether the advocacy duty applies;
5. Explain to them what to do if they change their mind about making their own arrangements;
6. Explain to them what they should do if their needs change; and
7. Carry out, or arrange to be carried out any processes to support carers.

All of the above information should be confirmed in writing.

Making sure needs are met

Where the person decides to make arrangements outside of the Local Authority to duty to meet eligible needs still applies until such time when the need is appropriately met. This means you will need to consider:

1. Information and advice required to ensure that any equipment or adaptation that the person arranges will meet their eligible needs; and
2. Supporting the person to access an appropriate provider;
3. The need to provide sort term equipment; and
4. Monitoring the situation to ensure that eligible needs are being met as intended.

9. Notifying others of the Outcome

When the referral was internal you should seek consent of the person to notify others of the outcome who:

1. Have not been involved in the assessment; but
2. Who have an interest in the outcome of the assessment; because
3. They have a role in supporting the person to meet any on-going needs.

Examples of people who you may need to notify include:

1. A social work practitioner;
2. A service provider;
3. The reablement service.

When notifying others you should explain:

1. The outcome of eligibility;
2. Whether Occupational Therapy services are appropriate;
3. Whether the person wishes for Occupational Therapy to arrange equipment or adaptations;
4. If so, what next steps have been agreed with the person;
5. If not, what the rationale is for the decision;
6. If not, what next steps have been agreed (or are required) to ensure that eligible needs are met.