Preventing Needs for Care and Support
1. When Prevention Applies
This general principle applies to all people from the age of 18. Other General Principles can apply from the age of 16 because they are relevant to young people going through the transition from children's social care to adult social care.This principle also only applies to people who are ordinarily resident in the Local Authority area.
2. Prevention and Wellbeing
One of the key elements of the Wellbeing principle is for the Local Authority to;
'Place importance on the prevention or delay of needs for formal or informal Care and Support, and the reduction of needs that already exist'.
In doing so the Local Authority should think about:
- How to identify prevention services already available in the local area and the extent to which they could involve or make use of them;
- How to identify people in the area with needs for Care and Support which are not being met (by the Local Authority or otherwise);
- How to identify carers in the area with needs for Support which are not being met (by the Local Authority or otherwise).
3. When to Provide Prevention Services
The Local Authorities responsibilities for prevention apply to all adults ordinarily resident in the local area, including;
- People who do not have any current needs for Care and Support;
- Adults with needs for care and support (whether their needs are eligible and/or met by the local authority or not); and
- Carers (including those who may be about to take on a caring role or who do not currently have any needs for support, and those with needs for support which may not be being met by the local authority or other organisation)
The Local Authority has a duty to provide prevention services (incorporating all services, facilities, resources or other necessary steps to prevent, delay or reduce needs) when it believes that such prevention services will:
- Contribute towards the prevention or delay of the need for Care and
- Contribute towards the prevention or delay of any need for Support of carers;
- Reduce the needs for Care and Support;
- Reduce the needs for Support of carers.
Because there is a duty to arrange prevention services this means that the Local Authority has to do so and cannot omit to do so (either because it declines to do so or chooses to support the person in other ways).
The duty to prevent needs for Care and Support/Support is section 2 of the Care Act. Whenever a document or person refers to section 2 of the Care Act they are referring to the duty to prevent needs for Care and Support/Support, even if they do not specifically use that phrase.
4. Different Types of Prevention Services for People with Care and Support Needs
Sometimes Prevention Services are not readily available in a community. In these situations the Care Act states that Local authorities should actively work with people, carers, their networks and local communities to create a solution. This is called Co-Production and working in this way can contribute to developing resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.
Primary Prevention Services
Also referred to as services that promote well-being, primary prevention services are usually aimed at people who have no current particular health or Care and Support needs. The aim is normally to avoid the development of needs in people or carers by maintaining their independence, good health and promoting their overall wellbeing. They are generally universal services, and may include:
- Universal access to good quality information and advice;
- Support safer neighbourhoods schemes;
- Activities that promote healthy and active lifestyles (e.g. exercise classes arranged through social prescribing);
- Schemes or activities to reduce loneliness or isolation (e.g. befriending schemes); and
- Discussions about potential changes in the future (e.g. conversations about potential care arrangements or suitable accommodation should a person become ill or disabled).
Secondary Prevention Services
Also known as Early Intervention Services, these are more targeted interventions aimed at people who have an increased risk of developing needs. The aim is to slow down or reduce any further deterioration or prevent additional needs from developing. Secondary prevention services may include:
- Helping someone with a learning disability to manage their finances through floating support;
- Provision of a few hours respite for a family carer who is supporting their husband with mental illness;
- Falls Prevention Clinics;
- Minor adaptations to the home e.g. grabrails; and
- Short term provision of mobility equipment or Telecare.
Steps should be taken by Local Authorities to proactively identify those people most likely to benefit from secondary prevention services.
Tertiary Prevention Services
Also referred to as Formal Services, tertiary prevention services endeavour to minimise the effect of disability or deterioration for people with established or complex health conditions and their carers, support people to regain skills and manage or reduce need where possible. Tertiary prevention services include:
- Reablement services to support people to regain skills at home after an accident or a period of illness; and
- Aids and adaptations in the home.
Intermediate Care Services
These are services provided to people (usually older people), after they have left hospital or when they are at risk of being sent to hospital. Intermediate Care Services are either bed –based (provided in a residential or nursing home) or home based (provided in the person's own home). Services are time limited to assist a person to maintain or regain the ability to live independently. When a person is receiving Intermediate Care there is normally an element of joined up working between health and social care.
Rehabilitation services describe services designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. They can include provisions to support the person become independent and remain or return to their home. Rehabilitation services are usually arranged and managed by health.
5. Types of Prevention Services for Carers
Examples of Prevention Services for carers include:
- Support to help them develop the knowledge and skills to care effectively for the person they look after (e.g. moving and handling, falls advice, behaviour management techniques);
- Support to help them develop knowledge and skills to look after their own health and Wellbeing (e.g. stress management classes);
- Respite care;
- Access to peer support groups e.g. Dementia Café;
- Support to make use of IT and other technology to make their life easier (e.g. to enable them to shop or bank on the internet);
- Advice about choices and options available to them and the person they care for;
- Support or services for the person to enable the carer to manage their caring role alongside paid employment; and
- Advice and support with benefits.
Prevention is not a one-off activity. A change in circumstances may result in a change to the type or prevention support that may be of benefit to the person and/or carer. Prevention services should always be considered when undertaking any action, function or decision under the Care Act.
6. Charging for Prevention Services
Prevention services, like other forms of Care and Support, are not always provided free, and charging for some services is vital to ensure affordability. The Care and Support (Preventing Needs for Care and Support) Regulations 2014 allows the Local Authority to make a charge for the provision of certain prevention services, facilities or resources. However, the regulations are also clear that some must be provided free of charge.
Prevention Services where the Local Authority may not charge
- Intermediate care and reablement services must be provided free of charge for up to 6 weeks
- Aids and minor adaptations (up to the value of £1000)
Prevention Services where the Local Authority has the power to charge (is able to make its own decision about charging/not charging)
- Intermediate care or reablement services that exceed 6 weeks.
- All other statutory or commissioned prevention services not yet mentioned.
The Care Act statutory guidance states that neither intermediate care nor reablement should be constrained by a strict time limit. Furthermore, the Care and Support (Preventing Needs for Care and Support) Regulations 2014 specify that the Local Authority should consider continuing to provide it free of charge beyond 6 weeks if:
- The person's needs have prevented them from engaging in the services in the same way as others without such needs;
- The outcomes and goals agreed at the start of the service were not realistic to be achieved within 6 weeks;
- There remains clear preventative benefits to the individual; and
- There remains a reduced risk of hospitalisation.
When charging for any type of prevention support, the Local Authority should take reasonable steps to ensure that any charge is affordable for the person concerned. This does not need to follow the method of the financial assessment used for mainstream charging purposes; indeed the Care Act statutory guidance states that the use of such a process is likely to be disproportionate. The Local Authority should consider adopting a more proportionate approach which ensures that charges are only paid by those who can afford to do so. In any event, the Local Authority must not charge more than it costs to provide or arrange for the service, facility or resource.
Non-Statutory and Non-Commissioned Prevention Services
Many of the prevention services, facilities or resources described above may not involve the Local Authority directly providing or commissioning the service. Some effective forms of prevention result from partnerships with other public services (e.g. health), voluntary and community organisations and other providers. In these situations the Local Authority will likely have no direct control on the amount these services charge the person. Thus, when developing partnerships the Local Authority should consider what obstacles there may be which might prevent people on low incomes from benefitting from the activities and take reasonable steps to avoid this from occurring.
Where the cost of a non-statutory or non-commissioned service prevents a person from participating and this poses a risk to the prevention, delay or reduction of needs or their Wellbeing the Local Authority can make provisions to provide the person with a Direct Payment to support with the costs (providing the person has eligible needs following assessment).
7. Ending Prevention Services
Under the Care Act there are no time restrictions on the duration of any prevention service. The Local Authority should consider the potential impact and consequences of ending the provision of preventative services for each person and consider extending the provision when there remains clear preventative benefits to the individual.
The termination of prevention services should be planned with the person and the Local Authority should be mindful that poorly considered exit strategies often negate the positive outcomes of the prevention service itself, and serve to increase the likelihood of need in the future.