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Cross Border Placements

1. An Introduction to Cross Border Placement Arrangements

Understanding cross border placement arrangements

Cross border placement arrangements are a statutory requirement of the Care Act. They define the way that local authorities in the different countries of the UK should work collaboratively when:

  1. Arranging cross border placements; and
  2. Managing cross border placements.

For the purposes of cross border placement arrangements, the different countries of the UK are:

  1. England;
  2. Wales;
  3. Scotland; and
  4. Northern Ireland.

There are 4 clear steps to the cross border placement arrangements, which have been agreed by all 4 countries:

  1. Care and Support Planning;
  2. Initial liaison between first and second authority;
  3. Ongoing management of the placement; and
  4. Confirmation of Placement.

Each step sets out the different requirements of:

  1. The first Local Authority (the place where the person lives now); and
  2. The second Local Authority (the place where the person may be moving to).

Guiding principles

At the centre of the arrangements are 2 guiding principles:

  1. A person-centred process, focussing on the Wellbeing of the person; and
  2. Reciprocity and Co-operation.

When to use cross border placement arrangements

Cross border placement arrangements should only be used when all of the following circumstances apply:

  1. The person has been assessed as having eligible care and support needs; and
  2. A care home placement is an appropriate and proportionate way to meet their eligible needs; and
  3. The first Local Authority is required to arrange the placement (or agrees to arrange the placement if requested to do so); and
  4. There are no suitable placements available locally (or in the same country of the UK); or
  5. There are suitable placements locally (or in the same country of the UK) but the first Local Authority agrees that a placement into another country is an appropriate and proportionate way to promote individual Wellbeing (for example if the person's only family live in that country).
Need to Know

If a person has eligible needs the first Local Authority is required to arrange a care home placement for them unless:

  1. The person will be self funding the placement; and
  2. They have capacity to make their own arrangements (either independently or with informal support).

In this case the first Local Authority can still decide to arrange the placement (in which case the cross border placement arrangements apply), but is under no obligation to do so.

When cross border placement arrangements do not apply

As the first Local Authority (where the person lives now)

The cross border placement arrangements should not be used when:

  1. A care home placement is not an appropriate or proportionate way to meet the person's eligible needs; or
  2. The Local Authority does not agree to arrange the placement (in situations when it is not required to do so); or
  3. The person is moving from one area to another area within the borders of England; or
  4. The person is moving as part of their Section 117 after care under the Mental Health Act 1983.
Need to Know

If a person is being placed in another country as part of their Section 117 after care under the Mental Health Act 1983:

  1. The cross border placement arrangements do not apply; because
  2. All aspects of their care or treatment remain the responsibility of the Local Authority area in which they were living at the time of section; and
  3. This includes arranging and managing a care home placement.

As the second Local Authority (where the person may be moving to)

The cross border placement arrangements may not apply if the first Local Authority has not:

  1. Assessed the person's eligible needs;
  2. Explored alternative ways to meet the person's needs;
  3. Considered available local placements; or
  4. Does not have a clear rationale for making the placement.

If you receive a request for cross border placement arrangements, but believe they may not be appropriate you should:

  1. Seek the advice of your line manager as required; and
  2. Request further evidence from the first Local Authority before making cross border arrangements.
Need to Know
If the cross border placement procedures do not apply it is still possible for a cross border placement to proceed, although this would be done so without the collaboration of the second Local Authority.

2. Step 1: Care and Support Planning

Using this section of the procedure

You should use this section of the procedure if you represent the first Local Authority (the area where the person lives now); and

  1. The person has been assessed as having eligible care and support needs; and
  2. A care home placement is an appropriate and proportionate way to meet their eligible needs; and
  3. The Local Authority is required to arrange the placement (or agrees to arrange the placement if requested to do so); and
  4. The person expresses a wish to move to another country to be closer to family or friends who live there already (or who will be re-locating there); or
  5. The person lacks capacity and their family and friends wish for them to move to another country to be closer to them; or
  6. The person requires residential care and there may be no appropriate options available locally, or in another area of England.

If you represent the second Local Authority (the area where a person may be moving to) click here.

Need to know
Although Step 1 is called 'Care and Support Planning' it can take place at assessment, Care and Support Planning, review or when carrying out any other care and support function with a person.

The purpose of Step 1

The purpose of step 1 is to ensure that a person is only ever placed into another area of the country because:

  1. There are no suitable placements available locally (or in the same country of the UK); or
  2. There are suitable placements locally (or in the same country of the UK) but the Local Authority agrees that a placement into another country is an appropriate and proportionate way to promote individual Wellbeing (for example if the person's only family live in that country).

Completing Step 1

There are several stages to completing Step 1:

  1. Identifying local options to meet eligible needs;
  2. Exploring the risks and benefits (of local options and of moving to the proposed country);
  3. Providing information and advice to the person (or their representative) about the implications of moving to another country;
  4. Making a decision about the appropriateness of a cross border placement; and
  5. If a cross border placement is agreed, identifying the preferred option.
Need to know

Conversations and decisions about cross border placements must involve:

  1. The person (or their representative if they lack capacity);
  2. Any carers;
  3. Any Deputy or Lasting Power of Attorney; and
  4. Any other organisation that may be jointly funding a placement (e.g. the CCG).

Identifying local options to meet eligible needs

It is important that you:

  1. Identify all of the possible local options, even if they do not appear to be viable at first;
  2. Only identify options that are available ;
  3. Only identify options that are within the resources of the Local Authority (or the person if they are self funding) to provide; and
  4. Take a positive approach to risk when identifying options.

Exploring risks and benefits

When all available local options have been identified, you must explore:

  1. The risks to the person from local options and the proposed move;
  2. The benefits to the person from local options and the proposed move;
  3. The likely impact of each risk or benefit on the person.

The following questions in particular should be considered to help establish the likely impact on the person of a move to the proposed country:

  1. Would the support network in the area being proposed improve (or at least maintain) the person's Wellbeing?
  2. What effect might the change of location have on the person's Wellbeing? How well are they likely to adapt to new surroundings? and
  3. Is the person in receipt of any specialist health care? If so, will the person be able to continue their treatment in the proposed country?

Providing information and advice

You should support the person (or their representative if they lack capacity) and their family to consider whether a cross border placement is something they wish to pursue by providing them with appropriate information and advice to make an informed decision.

The following information should be provided:

  1. If the person has a clear placement in mind, whether Local Authority resources would be likely to meet the cost (or whether a top-up would be required);
  2. The choice of provision that would likely be available in the other country, and how this compares with the provision available locally;
  3. How the second Local Authority would likely be involved in the management of any placement, including information that would need to be shared with them;
  4. How the involvement of any current professionals would be affected by the move (particularly if a role could cease); and
  5. How any urgent issues with the placement or any safeguarding concerns would be managed.

Appropriate cross border placements

A local placement would normally be the preferred option when:

  1. There is a local option available; and
  2. The risks to the person's Wellbeing from the local option are less than, or comparable to those that would exist in the other country; and
  3. The benefits to the person's Wellbeing from the local options are greater than, or equal to those that would exist in another country.

A cross border placement would normally be the preferred option when:

  1. A local option is not available; or
  2. A local option is available; but
  3. The benefits to the person's Wellbeing are greater than those that would exist in a local placement (particularly in regards to relationships with family and friends); and
  4. The risks to the person's Wellbeing from the move are minimal, or can be mitigated (particular in regard to the impact of the move itself and on any specialist health services they require).

If the person lacks capacity

If the person lacks capacity any decision about residence must be made in their Best Interests.

Click here to access 'Making Best Interest Decisions', which is part of the Mental Capacity Act 2005 Resource and Practice Toolkit.

Decisions about the Best Interests of the person must be made by the following persons where they exist:

  1. A Deputy appointed by the Court of Protection to make decisions about welfare matters; or
  2. A Lasting Power of Attorney authorised by the person to make the decision.

The Local Authority is under no obligation to arrange, fund a placement or apply the cross border placement procedures when:

  1. A Deputy or a Lasting Power of Attorney decides that a move to another country is in the person's Best Interests; but
  2. The Local Authority does not believe that a care home placement is the most appropriate way to meet the person's needs; or
  3. The Local Authority believes that a care home is appropriate but there are local options available; and
  4. The Local Authority does not believe, having weighed up the risks and benefits that a move to another country is in the person's Best Interests.

If there are concerns about the decision that has been made by a Deputy or Lasting Power of Attorney, the Local Authority should consider the need to:

  1. Raise a safeguarding concern;
  2. Notify the Office of the Public Guardian; or
  3. Make an application to the Court of Protection.

If a person proceeds to move to another country following a decision made by a Deputy or Lasting Power of Attorney, the Local Authority must ensure that they continue meeting the person's eligible needs until they have moved into the new placement.

Identifying the preferred option

The final stage of Step 1 is to identify which care home placements are available in the new country and decide which the preferred option is. This step should be carried out when:

  1. Local options to meet needs have been identified; and
  2. Risks and benefits have been explored (of local options and of moving to the proposed country); and
  3. Information and advice about the implications of moving to another country has been provided; and
  4. A decision has been made that a cross border placement should be arranged.

Depending on the circumstances, the person (or their family) may already have a preferred placement in mind. However, even if a person has a preferred placement you should still identify and explore other options, particularly if the cost of the preferred placement is outside of the local authority's available resources. This could prevent any unnecessary need for a third party top-up.

The process of identifying a preferred cross border placement option should reflect the process that you would use to identify a preferred local placement option. Depending on the person's needs and circumstances this could involve:

  1. Providing accessible information about different services (which you may have to gather through the information and advice services of the second Local Authority);
  2. Allowing time for the person (or their representative) to research the providers online or through making direct contact with them;
  3. The use of photographs to support a person to visualise a placement;
  4. Arranging for the provider to visit the person at home (if the provider is national);
  5. Arranging for the person to visit a placement and meet staff and people who live there;
  6. Testimonies of people already using a service.

It is important that you:

  1. Identify all of the possible options, even if they do not appear to be viable at first;
  2. Only identify options that are available ;
  3. Only identify options that are within the resources of the Local Authority (or the person if they are self funding) to provide; and
  4. Take a positive approach to risk when identifying options.

Seeking agreement in principle

Before you progress to any further steps you must:

  1. Complete a draft Care and Support Plan based upon the preferred placement option; and
  2. Seek agreement in principle from the Local Authority funding panel; and
  3. If agreed, confirm to the person that you are progressing to step 2, and what this entails.

3. Step 2: Initial Liaison between First and Second Authority

Using this section of the procedure

This section of the procedure should be used if you represent the first Local Authority (the area where the person lives now) and:

  1. Step 1 has been completed; and
  2. An agreement in principle to the preferred placement in the other country has been confirmed by the funding panel.

If you represent the second Local Authority (the area where a person may be moving to) click here.

The purpose of step 2

The purpose of step 2 is to:

  1. Notify the second Local Authority that the first Local Authority intends to place the person into their area; and
  2. Obtain additional information about the preferred placement option, to ensure that there are no quality or safeguarding issues; so that
  3. Any placement that was agreed in principle can be progressed and finalised as intended. 

Notifying the second Local Authority

The second Local Authority should be first notified by telephone, during which a named contact should be identified. During the telephone conversation you should:

  1. Confirm the intention of the first Local Authority to make a cross border placement; and
  2. Provide the date on which you intend the placement to start; and
  3. Provide the name and address of the proposed care provider; and
  4. Request information from the second Local Authority about any concerns they may have about the proposed placement, particularly whether they deem the placement to be unsuitable or unsafe.

Any telephone conversation should be confirmed in writing, with a letter to the named contact at the second Local Authority. A copy of the letter sent should be retained on the person's file.

The draft letter content below can be inserted into your Local Authority letter template and personalised for this purpose if required.

Example:

Dear (insert named contact),

Further to the initial contact made to (insert name) by (insert name) on (insert date) I write to confirm that it is the intention of (insert full name of first Local Authority) in the country of (insert name of country) to facilitate a cross border placement for Mr/Mrs/Miss/Ms (insert name) in (insert full name of the second Local Authority) in the country of (insert name of country).

The provisional date for the commencement of the placement is (insert date). The proposed placement is (insert name and address of proposed placement) and the care provider is (insert name of care provider).

Can you please let me know promptly if there are any issues regarding the proposed placement or provider, specifically around any quality or safeguarding concerns? If I do not hear from you within (insert timescale) I shall make the final arrangements for the placement and be in touch to discuss any support you may be able to provide under cross border placement arrangements.

Please do not hesitate to make contact if you require further information.

Yours sincerely

(insert name, job title and contact details).

If the second Local Authority objects

On occasion the second Local Authority may object to:

  1. The potential placement;  or
  2. To establishing cross border placement arrangements.

The second authority has no power to block a placement in its area, and should only raise concerns about entering into cross border placement arrangements when there is evidence that you:

  1. Have not assessed the person's eligible needs; or
  2. Have not explored alternative ways to meet the person's needs; or
  3. Have not considered available local placements; or
  4. Do not have a clear rationale for the placement.

If this occurs you should:

  1. Seek the advice of your line manager as required; and
  2. Ensure that you have completed step 1 adequately; and
  3. If so, provide further information to the second Local Authority to evidence this; and
  4. Proceed to arrange the placement, with or without the co-operation of the second Local Authority.

If a dispute with the second Local Authority persists you should refer to guidance in the Provisions of the Care and Support (Cross Border Placements and Business Failure) (Dispute Resolution) Regulations 2014. The regulations can be accessed by clicking here.

If concerns are raised about the proposed placement

If the second Local Authority raises concerns about the proposed placement you should take steps to reconsider the placement, as you would if concerns were raised about a local placement.

4. Step 3: On-going Management of the Placement

Using this section of the procedure

This section of the procedure should be used if you represent the first Local Authority (the area where the person lives now) and:

  1. Step 1 and 2 have been completed; and
  2. There have been no concerns raised about the proposed placement; or
  3. Any risks associated with the concerns have been mitigated; or
  4. An alternative placement in the new country has been identified; and
  5. The second Local Authority is agreeable to making cross border placement arrangements.

If you represent the second Local Authority (the area where a person may be moving to) click here.

The purpose of step 3

The purpose of step 3 is to agree:

  1. The non-statutory social work functions that the second Local Authority will carry out; and
  2. How the second Local Authority will support the first Local Authority to carry out its statutory social work functions; so that
  3. Any practical difficulties in the day to day management of the placement for the first Local Authority are overcome; and
  4. Any negative implications for the person are minimised.

Non-statutory social work functions

The nature of the social work functions required will vary depending on the needs and circumstances of the person. They could include:

  1. Wellbeing visits;
  2. Joint work with a health professional;
  3. Risk assessment;
  4. Liaison with the provider;
  5. Mental capacity assessment;
  6. Responding to urgent changes in need or circumstance (including providing urgent or interim alternative services in response to safeguarding or provider failure).

It is the responsibility of the first Local Authority to:

  1. Decide which non-statutory functions are required; and
  2. How often they are required; and
  3. How they wish to be notified of action carried out; and then
  4. Set this out clearly when negotiating with the second Local Authority.
Need to know
The second Local Authority may request reimbursement for any non-statutory functions it carries out, particularly if these are frequent, time consuming or non-reciprocal. If requested you should follow local available processes for agreeing and providing such reimbursement.

Support with statutory functions

All statutory functions (with the exception of new safeguarding enquiries) remain the ultimate responsibility of the first Local Authority. That said the cross border placement procedures do permit the second Local Authority to:

  1. Gather and provide information to the first Local Authority; and
  2. Carry out tasks to support them in fulfilling their statutory duties (such as gathering 'light touch' information to support a review outcome decision).

The second Local Authority should provide information to the first Local Authority:

  1. At the request of the first Local Authority; and
  2. As set out in the cross border placement arrangements; and
  3. Whenever the second Local Authority feels it would be beneficial; and
  4. Should be provided in a written format.

Negotiating with the second Local Authority

Negotiations should take place with the named contact at the second Local Authority, initially via telephone or e-mail.

The outcome of negotiations should be confirmed in writing, with a copy of the letter retained on the person's file.

The letter should clearly set out:

  1. The ongoing responsibilities of the first Local Authority;
  2. The non-statutory functions that the second Local Authority has agreed to carry out (including how often and any costs to be paid);
  3. The information that the second Local Authority has agreed to provide (and when);
  4. Any tasks that the second Local Authority has agreed to carry out to support the first Authorities statutory duties; and
  5. The specific arrangements in regards to reporting any safeguarding to the first Local Authority.

The draft letter content below can be inserted into your Local Authority letter template and personalised for this purpose if required.

Example:

Dear (insert named contact),

Further to the contact made on (insert date) I write to confirm the social work functions that you have agreed to provide regarding the cross border placement for Mr/Mrs/Miss/Ms (insert name) at (insert name and address of home/provider) scheduled for (insert planned move date).

(Insert full name of first Local Authority) will retain responsibility for statutory functions (excluding safeguarding), for funding and for the overall management of the placement. This includes the responsibility for Deprivation of Liberty Safeguards where they apply.

It has been agreed that you will assist (insert full name of first Local Authority) by carrying out the following non-statutory functions:

(List the functions that the second Local Authority has agreed to undertake on a regular or ad-hoc basis. Include details about frequency, how information about functions will be provided to the first Local Authority and any associated costs).

It has been agreed that you will assist (insert full name of first Local Authority) to carry out their statutory functions by gathering and providing information to them as requested, or that you feel it relevant to provide (insert if agreed-and by chairing review meetings).

Any safeguarding enquiries in relation Mr/Mrs/Miss/Ms (insert name) or to the placement in general will be your responsibility to manage. However, you must inform (insert full name of the first Local Authority) immediately or the next working day so that their views, and any need to carry out a placement review can be considered.

Please confirm in writing your agreement to the functions and responsibilities set out in this letter before the proposed placement start date.

Please do not hesitate to make contact if you require further information.

Yours sincerely

(Insert name, job title and contact details).

Confirmation of agreement

The second Local Authority should confirm their agreement to the cross border placement arrangements in writing upon receipt of the letter. This should be formally recorded.

If the second Local Authority does not confirm their agreement

If the placement date is approaching and you have not received confirmation of the cross border placement arrangements from the second Local Authority you should:

  1. Contact the named person at the second Local Authority; and
  2. Confirm that they received their letter; and
  3. Confirm whether their intention is to agree to the roles and responsibilities set out in it.

Arranging the placement

The placement itself should not be unnecessarily delayed to allow for cross border placement arrangements to be agreed, particularly if doing so will have a negative impact on the person's Wellbeing.

The placement should be arranged as per the processes set out in the 'Commissioning and Brokerage' procedure, which can be accessed by clicking here.

5. Step 4: Confirmation of Placement

When to use this section of the procedure

This section of the procedure should be used if you represent the first Local Authority (the area where the person lived previously) when:

  1. A cross border placement has been arranged; and
  2. Cross border placement agreements have been agreed; and
  3. The person moves to their new placement.

Transporting the person and their belongings

Wherever possible the person's family should make arrangements to move them (and their belongings) to the new placement.

If this is not possible the first Local Authority should support the person to make the necessary arrangements, which could include:

  1. Arranging removals;
  2. Arranging an escort;
  3. Meeting the cost of such arrangements (only if the person does not have the financial means to do so themselves); and
  4. Contacting the placement to confirm the person has arrived safely; and
  5. Requesting the second Local Authority carry out any Wellbeing visit that may be required.

Notifying the second Local Authority

You should notify the named contact at the second Local Authority in writing as soon as the person has moved into the new placement. This letter should also reiterate the roles and responsibilities previously agreed, and a copy should be retained on the person's file.

The draft letter content below can be inserted into your Local Authority letter template and personalised for this purpose if required.

Example:

Dear (insert named contact),

I am writing to confirm that the cross border placement for Mr/Mrs/Miss/Ms (insert name) at (insert name and address of home/provider) commenced as planned on (insert date).

As agree, (Insert full name of first Local Authority) will retain responsibility for statutory functions (excluding safeguarding), for funding and for the overall management of the placement. This includes the responsibility for Deprivation of Liberty Safeguards where they apply.

As agreed, (insert full name of second Local Authority) will assist (insert full name of first Local Authority) by carrying out the following non-statutory functions:

(List the functions that the second Local Authority agreed to undertake on a regular or ad-hoc basis. Include details about frequency, how information about functions will be provided to the first Local Authority and any associated costs).

It was also agreed that you will assist (insert full name of first Local Authority) to carry out their statutory functions by gathering and providing information to them as requested, or that you feel it relevant to provide (insert if agreed-and by chairing review meetings).

As agreed, any safeguarding enquiries in relation Mr/Mrs/Miss/Ms (insert name) or to the placement in general will be your responsibility to manage. However, you must inform (insert full name of the first Local Authority) immediately or the next working day so that their views, and any need to carry out a placement review can be considered.

Please commence the functions set out in these cross border placement arrangements, and do not hesitate to make contact if you require further information.

Yours sincerely

(Insert name, job title and contact details).

6. Requirements of the Second Local Authority

When to use this section of the procedure

This section of the procedure should be used when you represent the second Local Authority (the area where a person may be moving to). It will support you to understand the role of the second Local Authority in cross border placement arrangements.

Step 1: Care and Support Planning

This step of the cross border placement procedure does not apply to the second Local Authority.

However, if you are contacted for information relating to available placements in the area by the first Local Authority, or by the person or their family this should be made available in line with the statutory duty to provide good information and advice under the Care Act.

Step 2: Initial liaison between first and second Authority

Telephone notification

When notified of an intended cross border placement by the first Local Authority you should seek the following verbal information from the caller, which will help determine whether it is appropriate to make cross border placement arrangements:

  1. Confirmation that the person's eligible needs have been assessed; and
  2. Confirmation that alternative ways to meet the person's needs have been explored; and
  3. Confirmation that available local placements have been considered; and
  4. The rationale for the potential cross border placement.

If you believe the cross border placement procedures may not be appropriate you should:

  1. Seek the advice of your line manager as required; and
  2. Request further evidence from the first Local Authority; however
  3. You should be aware that you cannot block the proposed placement, even if cross border placement arrangements are not made.

If cross border placement arrangements seem appropriate you should:

  1. Provide the caller from the first Local Authority with a named contact, with who they can negotiate and agree arrangements (this may or may not be you); and
  2. Notify them of any safeguarding concerns or provider concerns regarding the proposed placement option that you are aware of.

Notification in writing

When the formal notification of the intended placement has been received in writing you should:

  1. Create an electronic record of the person;
  2. Make a proportionate record of the letter received; and
  3. Identify whether there are any safeguarding or provider concerns that it would be relevant to notify the first Local Authority about; and
  4. If so, notify them within the timeframe set out in the letter; then
  5. Await further contact from the first Local Authority to agree and negotiate cross border placement arrangements.

Step 3: Ongoing management of the placement

It is the responsibility of the first Local Authority (the area where the person lives now) to consider:

  1. The non-statutory social work functions it wishes the second Local Authority to complete;
  2. The assistance it wishes the second Local Authority to provide to support its own statutory functions;
  3. The manner and frequency in which it wants the second Local Authority to carry out those functions;
  4. The manner in which it wants the second Local Authority to provide information; and to
  5. Contact the second Local Authority to agree and negotiate those functions.

Costs

You should familiarise yourself with the local policy around charging the first Local Authority for any social work functions carried out on its behalf, or in the assistance of its own statutory duties.

Where there is a cost this must be clearly explained to the first Local Authority, and their agreement to meeting those costs must be provided before the cross border placement arrangements can be finalised.

Confirming arrangements

The first Local Authority should notify you in writing of the cross border placement arrangements agreed through negotiation. Until they do so no roles should be carried out unless the second Local Authority itself has a statutory duty to carry them out.

Upon receipt of the letter you should:

  1. Review the letter to make sure it reflects the roles agreed through negotiation;
  2. Make a proportionate record of the letter;
  3. Seek any authorisation from the second Local Authority as required; then
  4. If the arrangements reflect what was agreed through negotiation, write to the first Local Authority to provide formal notification of the second Local Authorities agreement to them.

Step 4: Confirmation of placement

After placement the first Local Authority should write to:

  1. Confirm the move has taken place; and
  2. Reiterate the cross border placement arrangements agreed; and
  3. Confirm the date that the arrangements are to commence.

Upon receipt of the letter you should:

  1. Contact the placement as required to advise them of your role;
  2. Arrange to meet the person, their family and any representatives as appropriate to explain your role; and
  3. Arrange to carry out functions as agreed in the cross border placement arrangements.

Carrying out social work functions

All social work functions that you carry out should be in line with:

  1. Care and Support procedures;
  2. Statutory requirements; and
  3. The agreed cross border placement arrangements.

Effective records of interventions, actions and decisions must be maintained, and information should be provided to the first Local Authority:

  1. As requested;
  2. As set out in the cross border placement arrangements; or
  3. Whenever the second Local Authority feels it would be beneficial; and
  4. Should be provided in a written format.

7. Statutory Reviews of Cross Border Placements

Need to know
This section of the procedure is supplementary to (and not a replacement of) the comprehensive review procedures that can be found within the 'Reviewing Support and Services' area of your team homepage.

The statutory review responsibility

The statutory review of the person's Care and Support Plan is always the ultimate responsibility of the first Local Authority (the authority that placed them). This is regardless of:

  1. The distance between the first Local Authority and the placement;
  2. The nature of the role that the second Local Authority has in the ongoing management of the placement, or
  3. The wishes of the person or their family.

The role of the first Local Authority

Deciding any role for the second Local Authority

It may be appropriate for the second Local Authority to gather 'light touch' information on behalf of the first Local Authority, without the need for the first Local Authority to be present when all of the following apply:

  1. The distance between the first Local Authority and the placement poses significant practical difficulty for the first Local Authority; and
  2. The second Local Authorities role in the review has been previously agreed in the cross border placement arrangements; or
  3. The second Local Authority agrees the role when asked; and
  4. The second Local Authority has been actively involved in the on-going management of the placement; and
  5. There are no issues with the placement, Care and Support Plan or personal budget.

If any of the following apply the first Local Authority should make their own arrangements to carry out the review in person, regardless of any cross border placement arrangements that may exist:

  1. There are concerns about the manner in which the second Local Authority is carrying out cross border placement functions; or
  2. Safeguarding concerns or enquiries carried out by the second Local Authority indicate the placement may be unstable or unsafe; or
  3. There are known changes in need or circumstance of the person; or
  4. There are changes required to the Care and Support Plan; or
  5. There may be changes required to the personal budget.

The first Local Authority should also consider visiting the person if the outcome of the last statutory review was based solely on the information provided by the second Local Authority.

If the second Local Authority is to assist

The first Local Authority should be satisfied that the second Local Authority will gather light touch review information with full regard for all statutory review requirements, particularly the requirement to maximise the involvement of the person.

Where the first Local Authority requires the second Local Authority to consult particular people, or to gather specific information this should be clearly set out to the second Local Authority.

The following should also be clearly set out:

  1. The timeframe for the review information to be gathered; and
  2. The manner in which the information is to be provided to the first Local Authority.

When information from the second Local Authority has been received the first Local Authority must consider whether the outcome of the review can be decided, or whether further information, consultation or action is required.

When making its decision the first Local Authority should consider:

  1. Whether the person's involvement was maximised by the second Local Authority;
  2. Any recommendations made by the second Local Authority;
  3. The views of the person;
  4. The views of others consulted; and
  5. The impact of any decision on the person's Wellbeing.

If the information gathered by the second Local Authority indicates any of the following, the first Local Authority should take steps to carry out any appropriate and proportionate reassessment of need:

  1. There are changes to the person's needs or circumstances;
  2. The personal budget is not sufficient;
  3. The placement is not appropriate.

If the first Local Authority is to carry out the review

Any review carried out by the first Local Authority must reflect the statutory requirements of all Care and Support Plan reviews.

The first Local Authority should also:

  1. Request relevant information from the second Local Authority;
  2. Consider any recommendations of the second Local Authority; and
  3. Consider the benefit of a representative from the second Local Authority being involved in any review meeting.

The role of the second Local Authority

Assisting in the statutory review function

Where the second Local Authority is to assist the review function by gathering 'light touch' information on behalf of the first Local Authority any information gathering should reflect the purpose and requirements of review, including:

  1. The requirement to involve the person;
  2. The requirement to provide independent advocacy;
  3. The need to establish what is working/not working about the Care and Support Plan;
  4. The need to consider whether anything needs to change about the Care and Support Plan;
  5. Identifying any potential change in need; and
  6. Identifying and taking steps to mitigate risk.
Need to know
If the person lacks capacity the second Local Authority must arrange to gather the review information through a face to face meeting.

After gathering the information required the second Local Authority should:

  1. Record the information in an appropriate format; and
  2. Provide this to the first Local Authority; so that
  3. The first Local Authority can decide whether any further information or action is required before deciding the outcome of the review.

The information provided should include:

  1. Recommendations for the first Local Authority to consider about the outcome of the review;
  2. The views of the person;
  3. The views of others consulted; and
  4. The impact of any decision on the person's Wellbeing.

If the first Local Authority is to carry out the review

If the second Local Authority is not going to be actively involved in the review process (as described above) they should be notified of the date that the first Local Authority intends to carry out the review, and should provide information:

  1. As requested;
  2. As set out in the cross border placement arrangements; or
  3. That they feel would be beneficial; and
  4. In an appropriate written format.
The second Local Authority should also consider any request made for them to be involved in a review meeting.

8. Safeguarding

Before the person moves

The first Local Authority has a statutory duty to:

  1. Respond to any safeguarding concerns; and
  2. Manage any safeguarding enquires; until
  3. The person has moved to the new placement in another country.

Any safeguarding enquiries on-going at the time of the move should be concluded by the first Local Authority, even if the person no longer lives in the area.

After the person moves

After the move the second Local Authority has a statutory duty to:

  1. Respond to any new safeguarding concerns; and
  2. Manage any safeguarding enquiries relating to those new concerns; unless
  3. Those concerns relate to harm or abuse that occurred (or may have occurred) in the first Local Authority area (see below).

When a new safeguarding concern has been made the second Local Authority:

  1. Must inform the first Local Authority; and
  2. Must notify the first Local Authority of the outcome; and
  3. Both authorities should consider the benefit in working together during the enquiry.

Notifications to the first Local Authority

Sometimes the first Local Authority will be notified of a safeguarding concern relating to the new placement by:

  1. The person;
  2. A family member of carer;
  3. A provider; or
  4. A professional involved with the person.

If notified of a concern the first Local Authority must:

  1. Immediately notify the second Local Authority of the concern; and
  2. Put in place arrangements to monitor the outcome; and
  3. Consider the need to carry out any other Care and Support function.

Concerns relating to abuse or neglect in the first Local Authority area

If a safeguarding concern relates to neglect or abuse that occurred (or may have occurred) in the first Local Authority area, the first Local Authority is responsible for:

  1. Responding to the concern; and
  2. Managing any safeguarding enquires; but
  3. Cross border placement arrangements can set out a role for the second Local Authority in assisting them to do so (for example speaking to the person to gather information).

Urgent alternative support

If the circumstances of the safeguarding indicate that the person requires an urgent alternative placement the second Local Authority should arrange a suitable placement, until such time as:

  1. The safeguarding enquiry is concluded; or
  2. The first Local Authority carries out any reassessment or Care and Support Planning required; and
  3. Makes longer term arrangements.
Any agreement to reimburse the second Local Authority for any costs it incurs in making urgent arrangements should be clearly set out in the cross border placement arrangements.

9. Monitoring Cross Border Placement Arrangements

The effectiveness of cross border placement arrangements should be monitored by both local authorities, and should be reviewed:

  1. At the request of either Authority; and
  2. At a statutory Care and Support Plan review; or
  3. If the person's needs or circumstances change; and
  4. In any urgent situation; and
  5. Following any safeguarding relating to the new placement.

Following a review any need to amend the arrangements should be considered, but the arrangements should not be terminated because there may always be a need for urgent intervention by the second Local Authority.

Any amendments a cross border placement arrangement should be confirmed in writing by the first Local Authority, and both should keep a formal record of the changes.

10. NHS Funded Nursing Care

The arrangements for the payment of NHS Funded Nursing Care are different, depending on the location of the first Local Authority.

If a person moves from Wales to England

If the person moves from Wales to England, it is the responsibility of the Welsh Local Authority to liaise with the local CCG in England before the person moves to make sure that their eligibility for NHS Funded Nursing Care is:

  1. Assessed; and
  2. If eligible paid to the new provider when the placement begins.

If a person moves from Northern Ireland or Scotland to England

If the person moves from either Northern Ireland or Scotland into England, the NHS body that was providing NHS Funded Nursing Care prior to their move remains responsible.

If a person moves from England into any other country

It is the responsibility of the first Local Authority to liaise with NHS bodies in Wales, Scotland or Northern Ireland before the person moves to make sure that their eligibility for NHS funded Nursing Care is:

  1. Assessed; and
  2. If eligible paid to the new provider when the placement begins.

11. Joint Funded Placements

Where services are funded jointly with a CCG in the first Local Authority area, that CCG continues to be jointly responsible for meeting the person's eligible needs, and for carrying out statutory functions (such as review) in a cross border placement when:

  1. There are no appropriate services locally; or
  2. The person has made a request that has been agreed under the Wellbeing principle; or
  3. The person lacks capacity and a cross border placement has been agreed as in their best interests.

12. Provider Failure and Complaints

Provider failure

If a cross border placement fails the second Local Authority should take steps to ensure that the person's care and support needs continue to be met in an appropriate setting until:

  1. The first Local Authority carries out any reassessment or Care and Support Planning required; and
  2. Makes longer term arrangements.

This responsibility should be clearly set out in the cross border placement arrangements, along with any agreement to reimburse the second Local Authority for any costs it incurs in making urgent or interim arrangements.

Provider complaints

It is the responsibility of the first Local Authority (the authority that arranged the placement) to investigate any formal complaint about the care provider relating to the person they placed there unless the person is self funding. In this case the person's complaint should be investigated internally by the care provider, and the first Local Authority should be notified of the outcome.

13. Managing Disputes between Local Authorities

Both the first and second Local Authorities should refer to guidance in the Provisions of the Care and Support (Cross Border Placements and Business Failure) (Dispute Resolution) Regulations 2014 in the event of any dispute about:

  1. The appropriateness of a cross border placement arrangement; or
  2. What particular cross border placement arrangements are required; or
  3. The costs requested by the second Local Authority to carry out social work functions; or
  4. The response of the second Local Authority to provider failure; or
  5. Any other aspect of cross border placement arrangements.

Click here to access the regulations.

Need to know
Under no circumstances should a dispute adversely affect the person's placement, or the meeting of their eligible care and support needs.

Telford Adult Social Care Procedures