1. Introduction

Under the Care Act 2014, the local authority has a duty to carry out their care and support responsibilities – including carer’s support and prevention services – with the aim of joining up services with those provided by the NHS and other health related services, for example, housing or leisure services.

The duty applies where the local authority considers that integration of services would promote the wellbeing of adults with care and support needs – including carers, contribute to the prevention or delay of developing care needs, or improve the quality of care in the local authority’s area.

2. Integrating Care and Support with other Local Services

There is a requirement that:

• the local authority must carry out its care and support responsibilities with the aim of promoting greater integration with NHS and other health related services;
• the local authority and its relevant partners must cooperate generally in performing their functions related to care and support; and supplementary to this;
• in specific individual cases, the local authority and its partners must cooperate in performing their respective functions relating to care and support and carers wherever they can.

This applies to all the local authority’s care and support functions for adults with needs for care and support and for carers, including:

• preventing needs (see Preventing, Reducing or Delaying Needs for Care and Support);
• providing information and advice (see Information and Advice);
• shaping and facilitating the market of service providers;
• safeguarding (see Safeguarding Enquiries Process);
• cross border placements (see Out of Area Arrangements);
• transition to adult care and support (see Transition to Adult Care and Support).

The local authority is not solely responsible for promoting integration with the NHS, and this responsibility reflects similar duties placed on NHS England and Integrated Care Boards (ICBs) to promote integration with care and support. There is also an equivalent duty on local authorities to integrate care and support provision with health related services, for example housing.

3. Multi Agency Working: Preventing Abuse and Neglect

See also Preventing Abuse and Neglect

Safeguarding adults from abuse and neglect is a fundamental part of the Care Act 2014. Identification and management of risk is an essential part of any assessment undertaken by a professional working with adults.

As noted above, the local authority must cooperate with its partners, and those partners must also cooperate with the local authority to provide care and support, and safeguard adults.

Relevant partners of the local authority include neighbouring authorities with whom they provide joint shared services and the following agencies or bodies who operate within the local authority’s area including:

• NHS England;
• Integrated Care Boards (ICBs);
• NHS trusts and NHS foundation trusts;
• Department for Work and Pensions;
• the police;
• prisons;
• probation services.

The local authority must also cooperate with such other agencies or bodies as it considers appropriate in exercising its adult safeguarding functions, including (but not limited to):

• general practitioners;
• dentists;
• pharmacists;
• NHS hospitals;
• housing, health and care providers.

All agencies should stress the need for preventing abuse and neglect wherever possible. Observant professionals and other staff making early, positive interventions with individuals and families can make a significant difference to their lives; preventing the deterioration of a situation or the breakdown of a support network. It is often when people become increasingly isolated and cut off from families and friends that they become extremely vulnerable to abuse and neglect.

All agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adult procedures.

Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk, through timely information sharing and multi-agency working. Multi-agency safeguarding hubs may be one model to support this but are not the only one. Policies and strategies for safeguarding adults should include measures to minimise the circumstances, including isolation, which make adults vulnerable to abuse.

See also Safeguarding Case Studies.

4. Integration and Cooperation: Safeguarding

Safeguarding requires collaboration between partners in order to create a framework of inter-agency arrangements.

The Care Act 2014 requires that local authorities and their relevant partners must collaborate and work together as set out in the cooperation duties in the Care Act and, in doing so, must, where appropriate, also consider the wishes and feelings of the adult on whose behalf they are working.

Local authorities may cooperate with any other body they consider appropriate where it is relevant to their care and support functions. The lead agency with responsibility for coordinating adult safeguarding arrangements is the local authority, but all the members of the South Tyneside Safeguarding Children and Adults Partnership should designate a lead officer. Other agencies should also consider the benefits of having a lead for adult safeguarding.

5. Strategic Planning

5.1 Integration with health and health related services

To ensure greater integration of services, the local authority should consider the different mechanisms through which it can promote integration, for example:

• planning: using adult care and support and public health data to understand the profile of the population and the needs of that population, for example, using information from the local Joint Strategic Needs Assessments (JSNA) to consider the wider need of that population in relation to housing (see Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies);
• commissioning: utilising JSNA data, joint commissioning can result in better outcomes for populations in the local area. This may include jointly commissioned advice services covering healthcare and housing, and services like housing related support that can provide a range of preventative interventions alongside care;
• assessment and information and advice: this may include integrating an assessment with information and advice about housing options on where to live, and adaptations to the home, care
• and related finance to help develop a care plan, and understand housing choices reflecting the person’s strengths and capabilities to help achieve their desired outcomes;
• delivery or provision of care and support: this is integrated with an assessment of the home, including general upkeep or scope for aids and adaptations, community equipment of other modifications could reduce the risk to health, help maintain independence or support reablement or recovery.

Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies are, therefore, key means by which local authorities work with Integrated Care Boards (ICBs) to identify and plan to meet the care and support needs of the local population, including carers.

6. Cooperation of Partner Organisations

Cooperation between partners should be a general principle for all those concerned, and all should understand the reasons why cooperation is important for those people involved. There are five aims of cooperation relevant to care and support, although the purposes of cooperation should not be limited to these matters:

1. promoting the wellbeing of adults needing care and support and of carers;
2. improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
3. smoothing the transition from children’s to adults’ services;
4. protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect;
5. identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.

6.1 Who must cooperate?

The local authority must cooperate with each of its relevant partners, and the partners must also cooperate with the local authority, in relation to relevant functions. There are specific ‘relevant partners’ who have a reciprocal responsibility to cooperate. These are:

• other local authorities within the area (in multi-tier authority areas, this will be a district council);
• any other local authority which would be appropriate to cooperate with in a particular set of circumstances (for example, another authority which is arranging care for a person in the home area);
• NHS bodies in the authority’s area (including primary care, Integrated Care Boards, any hospital trusts and NHS England, where it commissions health care locally);
• local offices of the Department for Work and Pensions (such as Job Centre Plus);
• police services in the local authority areas and prisons and probation services in the local area.

There may be other persons or bodies with whom a local authority should cooperate, in particular independent or private sector organisations for example care and support providers, NHS primary health providers, independent hospitals and private registered providers of social housing, the Care Quality Commission and regulators of health and social care professionals.

1. Introduction

People in custody or custodial settings who have needs for care and support should be able to access the care they need, just like anyone else. In the past, responsibilities for meeting the needs of prisoners were not always clear, and this led to confusion between local authorities, prisons and other organisations and made it difficult to ensure people’s eligible needs were met. The Care Act 2014 clarifies local responsibilities for people in custody with care and support needs.

Prisoners often have complex health and care needs and experience poorer health and mental health outcomes than the general population. Research has found higher rates of mental illness, substance misuse and learning disabilities among people in custody than in the general population. Access to good, joined up health and care support services is therefore important for these groups.

All adults in custody, as well as offenders in the community, should expect the same level of care and support as the rest of the population. This is crucial to ensure that those in the criminal justice system who are in need of care and support achieve the outcomes that matter to them, and that will support them to live as independently as possible at the end of their detention.

This chapter relates only to custodial settings in England.

1.1 Role of local authorities

Adults in a custodial setting should be treated as if they are ordinarily resident in the local authority area where the custodial setting is located (see Ordinary Residence chapter).

Adults who are bailed to a particular address in criminal proceedings are treated as ordinarily resident in the local authority area where they are required to reside as part of their bail conditions.

Local authorities are responsible for the assessment of all adults who are in custody in their area and who appear to be in need of care and support, regardless of which area they came from at the start of their detention or where they will be released to. If an adult is transferred to another custodial establishment in a different local authority area, responsibility will transfer to the new area. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of such care and support needs. Access to the internet may be limited in prisons and other custodial settings, so it is important to consider the most appropriate format for information and advice to be provided, such as easy read leaflets.

Although not all local authority areas contain prisons or approved premises, all areas will be responsible for ensuring continuity of care for adults with eligible needs who are released into their area with a package of care . Similarly local authorities must support continuity of care for any of their residents moving into custody.

2. Definitions

Prison: references to a prison include young offender institutions (which hold young people aged 15 -21 years), secure training centres or secure children’s homes. A reference to a governor, director or controller of a prison includes a reference to the governor, director or controller of a young offender institution, to the governor, director or monitor of a secure training centre and to the manager of a secure children’s home. A reference to a prison officer or prisoner custody officer includes a reference to a prison officer or prisoner custody officer at a young offender institution, to an officer or custody officer at a secure training centre and to a member of staff at a secure children’s home.

Approved premises: these are premises which are approved as accommodation under the Offender Management Act 2007 for the supervision and rehabilitation of offenders, and for people on bail. They are usually supervised hostel type accommodation.

HM Prison and Probation Service (HMPPS): is an executive agency, sponsored by the Ministry of Justice. The agency is made up of HM Prison Service, Probation Service and Youth Custody Service. Within England and Wales, HMPPS are responsible for:

• running prison and probation services;
• rehabilitation services for people leaving prison;
• ensuring the availability of support to stop people reoffending;
• contract managing private sector prisons and services such as:
  • the prisoner escort service;
  • electronic tagging.

Through HM Prison Service they manage public sector prisons and the contracts for private prisons in England and Wales.

Probation Service: the probation service is responsible for working with adult offenders, both in the community and during a move from prison to the community, to reduce reoffending and improve rehabilitation. The probation service sits within HMPSS.

HM Inspectorate of Prisons / Probation: HMI Prisons is an independent inspectorate which reports on conditions for and treatment of those in prison, young offender institutions and immigration detention facilities. HMI Probation is an independent inspectorate on the effectiveness of work with adults, children and young people who have offended aimed at reducing reoffending and protecting the public.

Prisons and Probation Ombudsman (PPO): PPO investigates complaints from prisoners, those on probation and those held in immigration removal centres. The Ombudsman also investigates all deaths that occur among prisoners, immigration detainees and the residents of approved premises.

3. Information Sharing

See also South Tyneside Multi-Agency Information Sharing Agreement

Local authorities are responsible for the security of information held on people who are in custodial settings, and should develop agreements with partner agencies in line with the policies and procedures of Ministry of Justice and HMPPS which enable appropriate information sharing on individuals, including the sharing of information about risk to the prisoner and others where this is relevant. See also Information Sharing Policy Framework (gov.uk).

If a local authority is providing care and support to a person who is remanded (awaiting trial) or sentenced to custody, bailed to approved premises, or required to live in approved premises as part of a community sentence, the recent assessment and care and support plan should be shared with the custodial setting and the local authority in which it is based (if different) so that care and support may continue.

Prisons and /or prison health services should inform their local authority when someone they believe has care and support needs arrives at their establishment (see Integration, Cooperation and Partnerships chapter). The local authority may also receive requests for information from managers of custodial settings or the probation service when an adult who has already received care and support in the community is remanded or sentenced to custody. The information requested should be provided as soon as possible.

The local authority and partners in the criminal justice system should put in place processes for identifying people in custodial settings who are likely to have or to develop care and support needs. This could include when the adult is screened on arrival at the prison or during health assessments.

4. Assessments of Need

When a local authority is informed that an adult in a custodial setting may have care and support needs, they must carry out an assessment as they would for someone in the community. The same standards and approach to assessment and decision making about whether someone has care and support needs should apply to adult in custodial settings, as to those who are not in the criminal justice setting, bearing in mind that an adult in prison will no longer have the same level of support they may have relied upon in the community. It is likely that there will be complexities for carrying out assessments in custodial settings and consideration should be given to how such assessments will be carried out in the most efficient way for all involved.

The local authority may also combine a needs assessment with any other assessment it is carrying out, or it may carry out assessments jointly with, or on behalf of another organisation, for example prisoners’ health assessments.

Adults in a custodial setting also have a right to self-refer for an assessment. The local authority should provide appropriate types of care and support prior to completion of the assessment, if the person has urgent needs.

If an adult in a custodial setting refuses a needs assessment, the local authority is not required to carry out the assessment, unless:

• the person lacks the mental capacity to refuse and the local authority believes that the assessment will be in their best interests; or
• the person is experiencing, or is at risk of, abuse or neglect (see Section 1, What is Safeguarding and Why does it Matter?).

Once a local authority has assessed an adult in custody as needing care and support it must decide if some or all of these needs meet the eligibility criteria.

Where an adult does not meet the eligibility criteria, they must be given written information about:

• what can be done to meet or reduce their needs and what services are available; and
• what can be done to prevent or delay the development of needs for care and support in the future.

4.1 Eligibility

The threshold for the provision of care and support does not change in custodial settings. When an adult is in a custodial setting, this should not in any way affect the assessment and recording of their eligible needs. However, the setting in which the care and support will be provided is likely to be different from community or other settings, and this should be taken into account during the care and support planning process when agreeing how best to meet the adult’s care and support needs. The extent and nature of their needs should be identified before taking into account the environment in which they live.

If a safeguarding issue is identified, the prison or approved premises management should be notified in line with with HMPPS policy on adult safeguarding.

4.2 Information

See also Information and Advice chapter

For any of the adult’s needs that are not eligible, the local authority must provide information and advice to them on how those needs can be met, and how they can be prevented from getting worse. It is good practice to copy this information to managers of custodial settings, with the adult’s consent, as this will help them manage their needs.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of care and support needs (see Preventing, Delaying or Reducing Needs chapter). Low level preventative support and information and advice can help adults in custody maintain their own health and wellbeing.

4.3 Choice of accommodation

The right to a choice of accommodation does not apply to those in a custodial setting except when an adult is preparing for release or resettlement in the community.

It is important that, where appropriate, adults in custodial settings, are supported to maintain links with their families, as long as this in the best interests of the adult and there are no public protection requirements or safeguarding concerns which may limit or prohibit family or other personal contact. While it may not always be possible or appropriate to involve family members directly in assessment or care planning, the adult should be asked whether they would like to involve others in these processes.

If it is not possible to involve families directly, the local authority should ask the adult if they would like others to be informed that an assessment is taking place and the outcome of that assessment and any care and support plan.

5. Carer’s Assessments

Prisoners, residents of approved premises or staff in prisons or approved premises will not take on the role of carer as defined by the Care Act and should therefore not in general be entitled to a carer’s assessment.

6. Charging and Assessing Financial Resources

As in the community, adults in custodial settings will be subject to a financial assessment to decide how much they may pay towards the cost of their care and support. Where it is unlikely the adult will be required to contribute towards the cost of their care and support ‘light touch’ assessments can be carried out. It the adult does not meet the eligibility threshold for local authority support, but wants to purchase care services, this request should be referred for decision to HMPPS.

7. After the Assessment

The local authority should ensure that all relevant partners are involved in care and support planning and take part in joint planning with health partners.

Where a local authority is required to meet needs for care and support, a care and support plan must be prepared.  The adult should be involved in this process. The local authority should also involve others concerned with the adult’s health and wellbeing, including prison staff, probation offender managers, staff of approved premises and health care staff, to ensure integration of care, as well as what is possible within the custodial regime. Any safeguarding issues are to be addressed in the care and support plan.

While every effort should be made to put adult’s in control of their care and for them to be actively involved and be able to influence the planning process. It should be explained that the custodial setting may limit the range of care options available and some, such as direct payments, do not apply in a custodial setting. Where an adult’s ability to exercise choice and control is limited in this way, this should be discussed with them and recorded as part of the care planning process. However, the plan must contain the elements as outlined in Chapter 10 Care and Support Planning, Care and Support Statutory Guidance, including the allocated personal budget. This will ensure that the adult is clear about the needs to be met, the cost of meeting those needs and how being in custody means their choice and control is limited.

The local authority should seek consent from the adult so that their care plans can be shared with other providers of custodial and resettlement services including custodial services, the probation service, prison healthcare providers and managers of approved premises as relevant. For residents of approved premises, the local authority should always liaise with the responsible offender manager in probation services.

7.1 Equipment and adaptations

If an adult needs equipment or adaptations to meet their care and support needs, this should be discussed with the prison, approved premises and health care services to identify which agency is responsible for providing them. Where this relates to fixtures and fittings (for instance a grab rail or a ramp), it will usually be for the prison to deliver this. But for specialised and moveable items such as beds and hoists, then it may be the local authority that is responsible. Aids for adults are the responsibility of the local authority, whilst more significant adaptations would the responsibility of the custodial establishment. See Adult Social Care Prison Service Instruction.

Care and support plans for those in custodial settings are reviewed in the same way as all other plans. The local authority should also review the adult’s care and support plan each time they go into custody from the community, or are released from custody.

8. Direct Payments

Direct payments do not apply in prisons and approved premises, and cannot be made to people in custodial settings.

Adults living in bail accommodation or approved premises who have not yet been convicted are entitled to direct payments, as they would have been whilst in their own homes.

9. Continuity of Care and Support when an Adult Moves

Adults in custody with care and support needs must have continuity of care if they are moved to another custodial setting and when they are being released from prison back into the community. Adults in custody cannot be said to be ordinarily resident there because the concept of ordinary residence is based on the person living there voluntarily. This means they might be ordinarily resident where they previously lived. However, it is the local authority where the custodial setting is situated which is responsible for assessments and services while the adult is in custody. When an adult is being released from prison, their ordinary residence will generally be in the local authority where they intend to live on a permanent basis.

There will be circumstances where the process to ensure continuity of care will need to differ, for example when a prisoner is moved between establishments or when they are released in another area because of the nature of their offence. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice, and adults can be moved between different custodial settings. In such cases, the Governor of the prison or a representative, should inform the local authority in which the prison is located (the first authority) that the adult is to be moved or is being released to a new area. If this is a move to a custodial setting or release into the community in the same authority, then the first authority will remain responsible for meeting the adult’s care and support needs. Where the new custodial setting or the community, if being released, is in a different local authority area (second authority), the first authority must inform the second authority of the move once it has been told by the prison.

The prison, both local authorities and where practicable, the adult should work together to ensure that the adult’s care and support is continued during the move. It is good practice for the first and second local authority (and the transferring and receiving prisons where appropriate) to have a named member of staff to lead on arrangements for individuals during the transfer. Both local authorities must share relevant information, including the adult’s care and support plan.

The second authority should assess the adult before they are moved, but this may not always be possible (for example, if they were informed of the transfer at short notice). In such circumstances the second authority must continue to meet the care and support needs that the first authority was meeting until it has carried out its own assessment.

10. People Leaving Prison: Ordinary Residence

The Care Act states that in most circumstances, a person’s ordinary residence is retained where they have their needs met in certain types of accommodation in another local authority area. However, this does not apply to people who are leaving prison.

Therefore, where an adult requires a specified type of accommodation (see Ordinary Residence chapter) to be arranged on release from prison to meet their eligible needs, the local authority should start from an assumption that they remain ordinarily resident in the area in which they were ordinarily resident before the start of their sentence.

However, deciding an adult’s ordinary residence on release from prison will not always be straightforward and each case must be considered on an individual basis. For example, it may not be possible for an adult to return to their prior local authority area due to the history of their case and any risks associated with them returning to that area.

In situations where an adult is likely to have needs for care and support services on release from prison or approved premises and their place of ordinary residence is unclear and / or they express an intention to settle in a new local authority area, the local authority to which they plan to move should take responsibility for carrying out their needs assessment.

Given the difficulties associated with deciding ordinary residence on release, prisons or approved premises, the probation service and the local authority providing care and support should initiate joint planning for release in advance. Early involvement of all agencies, particularly the probation service, should ensure that the resettlement plan is workable in the local authority area where the adult will live.

11. End of Life Care

The provision of care and support for those in custodial settings also applied to those who reach the end of life whilst in prison. Some adults will transfer to a local hospital, hospice or care home or move to an alternative prison for palliative care. In these cases, responsibility for care and support will pass to the NHS or new local authority, once the adult arrives at the new location. Approved premises are not usually a suitable location for the provision of end of life care.

Prison managers and health care providers should consider informing local authorities when a prisoner receives a terminal diagnosis or their condition deteriorates significantly. The adult’s consent to share such information should be obtained where possible.

Where it is not possible to obtain consent to share this information, managers of custodial settings and health care providers should make an individual assessment and consider the legal basis for sharing information (see Data Protection chapter).

Local authorities should work with the prison healthcare provider to ensure that the care and support needs of the prisoner are met throughout the provision of end of life care.

12. NHS Continuing Healthcare

NHS Continuing Healthcare (CHC) is arranged and funded by the NHS and provided to adults who have been assessed as having a ‘primary health need’. It is provided to people aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. NHS Continuing Healthcare is not dependent on a person’s condition or diagnosis but is based on their specific care needs.

13. Safeguarding Adults

See Safeguarding Enquiries Process

Local authority staff and care providers must understand what to do where they have a concern about abuse and / or neglect of an adult in custody. Prison and probation staff may approach the local authority for advice and assistance with adult safeguarding concerns in individual, but the local authority does not have the legal duty to lead safeguarding enquiries in any custodial setting.

14. Transition from Children’s to Adult Care and Support

Local authorities should have processes to identify young people in young offender institutions, secure children’s homes, secure training centres or other places of detention as well as young people in the youth justice system, who are likely to have eligible needs for care and support as adults, and who are approaching their eighteenth birthday. These young people should receive a transition assessment when appropriate (see Transition to Adult Care and Support chapter).

This also applies where a young person moves from a young offender institution to an adult prison, which may change which local authority is responsible for them. A request for an assessment can be made on the young person’s behalf by the professional responsible for their care in the young offenders’ institution, secure children’s home or secure training centre.

15. Care Leavers

If a young person is entitled to care and support and services as a care leaver, this status remains unchanged while they are in custody and the local authority that looked after the young person retains responsibility for providing leaving care services during their time in custody and on release.

Local authorities have a duty to provide personal adviser (PA) support to all care leavers up to age 25, if they want this support.

16. Independent Advocacy Support

Adults in custody are entitled to the support of an independent advocate during needs assessments and care and support planning and reviews of plans if they would have significant difficulty in being involved in the process. It is the local authority’s duty to arrange an independent advocate, as they would for an individual in the community (see Independent Advocacy chapter).

The local authority should agree with managers of custodial establishments how the advocacy scheme will work in their establishments.

17. Investigations

The Prisons and Probation Ombudsman (PPO) conducts investigations in prisons following complaints about prison services, as well as deaths in custody or other significant events. The PPO will commission a relevant body to assist their investigations where it is felt that an aspect of care and support provision has contributed to the event. The local authority should co- operate with any investigations as required.

1. Introduction

Transition is the term used to describe the process which is in place to support young people and their families move from services they have received as a child into those that they need when they become an adult.

Effective person centred transition planning is essential to help young people and their families prepare for adulthood. Transition to adult care and support comes at a time when a lot of change can take place in a young person’s life. It can also mean changes to the care and support they receive from education, health and care services, or involvement with new agencies such as those who provide support for housing, employment or further education and training.

The years in which a young person is approaching adulthood should be full of opportunity. Some of the issues that matter for young people approaching adulthood, and their families, may include (but are not limited to):

• paid employment;
• good health;
• completing exams or moving to further education;
• independent living (choice and control over one’s life and good housing options);
• social inclusion (friends, relationships and community).

The wellbeing of each young person or carer must be taken into account so that assessment and planning is based around the individual needs, wishes, and outcomes which matter to that person (see Promoting Wellbeing chapter).

Historically, there has sometimes been a lack of effective planning for people using children’s services who are approaching adulthood. Looked after children, young people with disabilities, and carers are often among the groups of people with the lowest life chances. Early conversations provide an opportunity for young people and their families to reflect on their strengths, needs and desired outcomes, and to plan ahead for how they will achieve their goals.

Professionals from different agencies, families, friends and the wider community should work together in a coordinated manner around each young person or carer to help raise their aspirations and achieve the outcomes that matter to them.

The purpose of carrying out transition assessments is to provide young people and their families with information so that they know what to expect in the future and can prepare for adulthood.

Transition assessments can develop solutions which do not necessarily involve the provision of services, and which may aid planning that helps to prevent, reduce or delay the development of needs for care or support.

2. When a Transition Assessment must be Carried Out

Transition assessments should take place at the right time for the young person or carer and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like after the young person in question turns 18. There is no set age when young people reach this point; every young person and their family are different, and as such, transition assessments should take place when it is most appropriate for them.

The local authority must carry out a transition assessment of anyone in the three  groups when there is significant benefit to the young person or carer in doing so, and if they are likely to have needs for care or support after turning 18. The provisions in the Care Act relating to transition to adult care and support are not only for those who are already receiving children’s services, but for anyone who is likely to have needs for adult care and support after turning 18.

3. Significant Benefit

When considering if it is of ‘significant benefit’ to assess, the local authority should consider the circumstances of the young person or carer, and whether it is an appropriate time for the young person or carer to undertake an assessment which helps them to prepare for adulthood.

The consideration of ‘significant benefit’ is not related to the level of a young person or carer’s needs, but rather to the timing of the transition assessment.

When considering whether it is of significant benefit to assess, a local authority should consider factors which may contribute to establishing the right time to assess (including but not limited to the following):

• the stage they have reached at school and any upcoming exams;
• whether the young person or carer wishes to enter further / higher education or training;
• whether the young person or carer wishes to get a job when they become a young adult;
• whether the young person is planning to move out of their parental home into their own accommodation;
• whether the young person will have care leaver status when they become 18;
• whether the carer of a young person wishes to remain in or return to employment when the young person leaves full time education;
• the time it may take to carry out an assessment;
• the time it may take to plan and put in place the adult care and support;
• any relevant family circumstances;
• any planned medical treatment/

For young people with special educational needs or disabilities (SEND) who have an education, health and care (EHC) plan under the Children and Families Act 2014, preparation for adulthood must begin from year 9 – see Special Educational Needs & Disability (SEND) Code of Practice. The transition assessment should be undertaken as part of one of the annual statutory reviews of the EHC plan, and should inform a plan for the transition from children’s to adult care and support.

Equally for those without EHC plans, early conversations with local authorities about preparation for adulthood are beneficial – when these conversations begin to take place will depend on individual circumstances.

For care leavers, local authorities should consider using the statutory Pathway Planning process as the opportunity to carry out a transition assessment where appropriate.

Local authorities should not carry out the transition assessment at inappropriate times in a young person’s life, such as when they are sitting their exams and it would cause disruption. The SEND Code of Practice similarly states that local authorities must minimise disruption to the child and their family – for example by combining multiple appointments where possible. Local authorities should seek to agree the best time for assessments and planning with the young person or carer, and where appropriate, their family and any other relevant partners.

In more complex cases, it can take some time not only to carry out the assessment itself but to plan and put in place care and support. Social workers will often be the most appropriate lead professionals for complex cases. Transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.

When transition assessments take place too late and care and support is arranged in a hurry, it can result in care and support which does not best meet the young person or carer’s needs – and sometimes at greater financial cost to the local authority than if it had been planned properly in advance.

4. Requests for Transition Assessment

A young person or carer, or someone acting on their behalf, has the right to request a transition assessment. The local authority must consider such requests and whether the likely need and significant benefit conditions apply – and if so it must undertake a transition assessment.

5. Refusal of Transition Assessment

If the local authority thinks these conditions do not apply and refuses an assessment on that basis, it must provide its reasons for this in writing in a timely manner, and it must provide information and advice on what can be done to prevent or delay the development of needs for support.

Where someone is refused (or they themselves refuse) a transition assessment, but at a later time makes a request for an assessment, the local authority must again consider whether the likely need and significant benefit conditions apply, and carry out an assessment if so.

6. Identifying Young People and Young Carers who are not already receiving Children’s Services

Most young people who receive transition assessments will be children in need under the Children Act 1989 and will already be known to local authorities.

However, local authorities should consider how they can identify young people who are not receiving children’s services who are likely to have care and support needs as an adult. Key examples include:

• young people with degenerative conditions;
• young people (for example with autism) whose needs have been largely met by their educational institution, but who once they leave, will require their needs to be met in some other way;
• young people detained in the youth justice system who will move to the adult custodial estate;
• young carers whose parents have needs below the local authority’s eligibility threshold but may nevertheless require advice or support to fulfil their potential, for example a child with deaf parents who is undertaking communication support;
• young people and young carers receiving Children and Adolescent Mental Health Services (CAMHS) may also require care and support as adults even if they did not receive children’s services from the local authority.

Even if they are not eligible for services, a transition assessment with good information and advice about support in the community can be particularly helpful for these groups as they are less likely to be aware of this.

When young people who have not been in contact with children’s services present to the local authority as a young adult, they often do so with a high level of need for care and support. Local authorities should consider how to work with education and health services to identify these groups as early as possible so they can plan and prevent the development of care and support needs (see Integration, Cooperation and Partnerships and Special Educational Needs & Disability (SEND) Code of Practice ‘Preparing for Adulthood’).

7. Adult Carers and Young Carers

Preparation for adulthood will involve assessing how the needs of young people change as they approach adulthood and also how carers’, young carers’ and other family members’ needs might change over time.

The local authority must assess the needs of an adult carer where there is a likely need for support after the child turns 18 and it is of significant benefit to the carer to do so. For instance, some carers of disabled children are able to remain in employment with minimal support while the child has been in school. However, once the young person leaves education, it may be the case that the carer’s needs for support increase, and additional support and planning is required from the local authority to allow the carer to stay in employment.

The local authority must also assess the needs of young carers as they approach adulthood. For instance, many young carers feel that they cannot go to university or enter employment because of their caring responsibilities. Transition assessments and planning must consider how to support young carers to prepare for adulthood and how to raise and fulfil their aspirations.

The local authority must consider the impact on other members of the family (or other people the authority may feel appropriate) of the person receiving care and support. This will require the authority to identify anyone who may be part of the person’s wider network of care and support. For example, caring responsibilities could have an impact on siblings’ school work, or their aspirations to go to university. Young carers’ assessments should include an indication of how any care and support plan for the person/s they care for would change as a result of the young carer’s change in circumstances. For example, if a young carer has an opportunity to go to university away from home, the local authority should indicate how it would meet the eligible needs of any family members that were previously being met by the young carer.

8. Features of a Transition Assessment

The transition assessment should support the young person and their family to plan for the future, by providing them with information about what they can expect. All transition assessments must include an assessment of:

• current needs for care and support and how these impact on wellbeing;
• whether the child or carer is likely to have needs for care and support after the child in question becomes 18;
• if so, what those needs are likely to be, and which are likely to be eligible needs;
• the outcomes the young person or carer wishes to achieve in day to day life and how care and support (and other matters) can contribute to achieving them.

Transition assessments for young carers or adult carers must also specifically consider whether the carer:

• is able to care now and after the child in question turns 18;
• is willing to care now and will continue to after 18;
• works, or wishes to do so;
• is or wishes to participate in education, training or recreation.

The young person or carer in question must be involved in the assessment for it to be person centred and reflect their views and wishes. The assessment must also involve anyone else who the young person or carer wants to involve in the assessment. For example, many young people will want their parents involved in their process.

9. Capacity

See also Mental Capacity chapter

In all cases, the young person or carer in question must agree to the assessment where they have mental capacity and are competent to agree. Where a young person or carer lacks mental capacity or is not competent to agree, the local authority must be satisfied that an assessment is in their best interests. Everyone has the right to refuse a transition assessment, however the local authority must undertake an assessment regardless if it suspects that a child is experiencing or at risk of abuse or neglect.

The right of young people to make decisions is subject to their capacity to do so as set out in the Mental Capacity Act 2005. The underlying principle of the Act is to ensure that those who lack capacity are supported to make as many decisions for themselves as possible, and that any decision made or action taken on their behalf, is done so in their best interests. This is a necessity if the transition assessment is to be person centred.

For young people below the age of 16, local authorities will need to establish a young person’s competence using the test of ‘Gillick competence’ (whether they are able to understand a proposed treatment or procedure). Where the young person is not competent, a person with parental responsibility will need to be involved in their transition assessment, – or an independent advocate provided if there is no one appropriate to act on their behalf (either with or without parental responsibility).

10. Independent Advocacy

The Care Act places a duty on local authorities to provide an independent advocate to facilitate the involvement in the transition assessment where the person in question would experience substantial difficulty in understanding the necessary information or in communicating their views, wishes and feelings – and if there is nobody else appropriate to act on their behalf (see Independent Advocacy chapter). This duty applies for all young people or carers who meet the criteria, regardless of whether they lack mental capacity as defined under the Mental Capacity Act 2005.

11. Information Sharing

When sharing information with a young carer about the person they care for a supported self-assessment during transition, the local authority must be satisfied that it is appropriate for the young carer to have the information. They must have regard to all circumstances in taking this decision, especially the age of the young carer, however each case will be different and there is no one age at which a young carer is necessarily old enough to receive information. The local authority must ensure that the adult consents to have their information shared in this way.

12. Cooperation between Professionals and Organisations

People with complex needs for care and support may have several professionals involved in their lives, and numerous assessments from multiple organisations. For children with special educational needs, the Children and Families Act 2014 brings these assessments together into a coordinated EHC plan (see SEND Code of Practice, Chapter 9).

Local authorities must cooperate with relevant partners, and this duty is reciprocal (see Integration, Cooperation and Partnerships chapter). This includes an explicit requirement which states that children and adult services must cooperate for the purposes of transition to adult care and support. Often, staff working in children’s services will have built relationships and knowledge about the young person or carer in question over a number of years. As young people and carers prepare for adulthood, children’s services and adults’ services should work together to pass on this knowledge and build new relationships in advance of transition.

It can be frustrating for children and families who have to attend multiple appointments for assessments, and who have to give out the same information repeatedly. The SEND Code of Practice highlights the importance of the ‘tell us once’ approach to gathering information for assessments and this will be important in other contexts as well. The local authority should consult with the young person and their family to discuss what arrangements they would prefer for assessments and reviews.

All relevant partners should be involved in transition planning where they are involved in the person’s care and support.

Equally, the local authority should be involved in transition planning led by another organisation, for example a child and adolescent mental health service, where there are also likely to be needs for adult care and support.

Agencies should agree how to organise transition assessments so that all the relevant professionals are able to contribute. For example, this might involve arranging a multi-disciplinary team meeting with the young person or carer. However, it may not always be possible for all the professionals from different agencies to be present at appointments, but they should still be enabled to contribute. Transition assessments must be person centred, which means that contributions by different agencies should reflect the views of the person to whom the assessment relates.

12.1 Care coordination

Many people value having one designated person who coordinates assessments and transition planning across different agencies, and helps them to navigate through numerous systems and processes that can sometimes be complicated.

Often there is a natural lead professional involved in a young person’s care who fulfils this role and the local authority should consider formalising this by designating a named person to coordinate transition assessment and planning across different agencies, and may also wish to consider setting up specialist posts carry out this coordination function for people who are preparing for adulthood.

This coordinating role, sometimes referred to as a ‘key working’ or ‘care coordination’, can not only help to deliver person centred, integrated care, but can also help to reduce bureaucracy and duplication for local authorities, the NHS and other agencies. Care coordinators are also often able to build close relationships with young people and families and can act as a valuable provider of information and advice both to the families and to local authorities. Care leavers will have Personal Advisers to provide support, for example by providing advice or signposting the young person to services. The Personal Adviser will be a natural lead in many cases to coordinate a transition from children’s to adult care and support where relevant (see also Transitions Case Studies).

13. Eligibility

Having carried out a transition assessment, the local authority must give an indication of which needs are likely to be eligible needs (and which are not likely to be eligible) once the young person in question turns 18, to ensure that the young person or carer understands the care and support they are likely to receive and can plan accordingly.

There is a particularly important role for local authorities in ensuring that young people and carers understand their likely situation when they reach adulthood. The different systems for children’s and adult care and support mean that there will be circumstances in which needs that were being met by children’s services may not be eligible needs under the adult system.

Adult care and support is subject to means testing and charging.

Where the transition assessment identifies needs that are likely to be eligible, local authorities should consider providing an indicative personal budget, so that young people, carers and their families are able to plan their care and support before entering the adult system (see SEN code of practice for further information about right to a personal budget for people with EHC plans).

For any needs that are not eligible under the adult statute, local authorities must provide information and advice on how those needs can be met, and how they can be prevented from getting worse.

14. Transition Plans

The local authority and relevant partners should consider building on a transition assessment to create a person-centred transition plan that sets out the information in the assessment, along with a plan for the transition to adult care and support, including key milestones for achieving the young person or carer’s desired outcomes.

In the case of an adult carer, if the local authority has identified needs through a transition assessment which could be met by adult services, it may meet these needs under the Care Act in advance of the child being cared for turning 18.

In deciding whether to do this the local authority must have regard to what support the adult carer is receiving under children’s legislation.

If the local authority decides to meet the adult carer’s needs through adult services, as for anyone else under the adult legislation, the adult carer must receive a support plan and a personal budget – as well as a financial assessment if they are subject to charges for the support they will receive.

15. Moving to Adult Care after the Young Person or Carer turns 18

There is no obligation on the local authority to move from children’s social care to adult care and support as soon as someone turns 18.

Very few moves will take place on the day of someone’s 18th birthday.

For the most part, the move to adult services begins at the end of a school term or another similar milestone, and in many cases should be a staged process over several months or years.

Prior to the move taking place, the local authority must decide whether to treat the transition assessment as a needs or carers assessment under the Care Act.

In making this decision the local authority must take into account when the transition assessment was carried out and whether the person’s circumstances have changed.

If the local authority will meet the young person’s or carer’s needs under the Care Act after they have turned 18 (based either on the existing transition assessment or a new needs assessment if necessary), the local authority must then undertake the care planning process as for other adults – including creating a care and support plan and producing a personal budget.

The local authority should ensure that this happens early enough that a package of care and support is in place at the time of transition.

16. Continuity of Care after the age of 18

Young people and their carers have sometimes faced a gap in provision of care and support when they turn 18, and this can be distressing and disruptive to their lives.

The local authority must not allow a gap in care and support when young people and carers move from children’s to adult services.

If transition assessment and planning is carried out as it should be, there should not be any gap in provision of care and support.

However, if adult care and support is not in place on a young person’s 18th birthday, and they or their carer have been receiving services under children’s legislation, the local authority must continue providing services until the relevant steps have been taken, so that there is no gap in provision.

The ‘relevant steps’ are if the local authority:

• concludes that the person does not have needs for adult care and support;
• concludes that the person does have such needs and begins to meet some or all of them (the local authority will not always meet all of a person’s needs – certain needs are sometimes met by carers or other organisations);
• concludes that the person does have such needs but decides they are not going to meet any of those needs, for instance, because their needs do not meet the eligibility criteria under the Care Act 2014.

In order to reach such a conclusion, the local authority must have conducted a transition assessment (that they will use as a needs or carers assessment under the adult statute).

Where a transition assessment was not conducted and should have been (or where the young person’s circumstances have changed), the local authority must carry out an adult needs or carer’s assessment.

In the case of care leavers, the Staying Put Guidance (HM Government, 2013) states that local authorities may choose to extend foster placements beyond the age of 18. All local authorities must have a Staying Put policy to ensure transition from care to independence and adulthood that is similar for care leavers to that which most young people experience, and is based on need and not on age alone.

For some people with complex SEN and care needs, local authorities and their partners may decide that children’s services are the best way to meet a person’s needs – even after they have turned 18. Both the Care Act 2014 and the Children and Families Act 2014 allow for this.

The Children and Families Act enables local authorities to continue children’s services beyond age 18 and up to 25 for young people with EHC plans if they need longer to complete or consolidate their education and training and achieve the outcomes set out in their plan.

Under the Care Act 2014, if, having carried out a transition assessment, it is agreed that the best decision for the young person is to continue to receive children’s services, the local authority may choose to do so.

Children and adults’ services must work together, and any decision to continue children’s services after the child turns 18 will require agreement between children and adult services.

Where a person over 18 is still receiving services under children’s legislation through their EHC plan and the EHC plan ceases, the transition assessment and planning process must be undertaken. Where this has not happened at the point of transition, the requirement under the Care Act to continue children’s services (as set out above) applies.

Both the Children and Families Act 2014 and the Care Act 2014 also require young people and their parents to be fully involved making decisions about their care and support. This includes decisions about the most appropriate time to make the transition to adult services.

The EHC plan or any transition plan should set out how this will happen, who is involved and what support will be provided to make sure the transition is as seamless as possible.

17. Safeguarding after the age 18

Where someone is over 18 but still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with by the adult safeguarding team (see Safeguarding Enquiries Process).

Where appropriate, they should involve the local authority’s children’s safeguarding colleagues as well as any relevant partners (for example police or NHS) or other persons relevant to the case.

The same approach should apply for complaints or appeals, as well as where someone is moving to a different local authority area after receiving a transition assessment but before moving to adult care and support.

18. Transition from Children’s to Adult NHS Continuing Health Care

ICBs should use the National Framework for NHS Continuing Healthcare and supporting guidance and tools (especially the Decision Support Tool) to determine what ongoing care services people aged 18 years or over should receive.

The framework sets out that ICBs should ensure that adult NHS continuing healthcare is assessed at all transition planning meetings for all young people whose may be potential eligibility.

ICBs and LAs should have systems in place to ensure that appropriate referrals are made whenever either organisation is supporting a young person who, on reaching adulthood, may have a need for services from the other agency.

The framework sets out best practice for the timing of transition steps as follows:

• children’s services should identify young people with likely needs for NHS Continuing Health Care and notify the relevant ICB when such a young person turns 14;
• there should be a formal referral for adult NHS CHC screening at 16;
• there should be a decision in principle at 17 so that a package of care can be in place once the person turns 18 (or later if agreed more appropriate).

Where a young person has been receiving children’s continuing health care, it is likely that they will continue to be eligible for a package of adult NHS CHC when they reach the age of 18.

Where their needs have changed such that they are assessed as no longer requiring such a package, they should be advised of this and of their right to request an independent review and mediation

The ICB should continue to participate in the transition process, in order to ensure an appropriate transfer of responsibilities, including consideration of whether they should be commissioning, funding or providing services towards a joint package of care.

Where it will benefit a young person with an EHC plan, local authorities have the power to continue to provide children’s services past a young person’s 18th birthday for as long as is deemed necessary.

Where there is a change in CHC provision, this must be recorded in the young person’s EHC plan, where they have one, and the young person must be advised of their right to ask the local authority for mediation up to the age of 25 (see SEND Code of Practice).

Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan, or the support plan in the case of carers.

The guiding principles in the development of the plan are that the process should be person centred and person led, in order to meet the needs and achieve the outcomes of the person in ways that work best for them as an individual or as part of a family.

The process and the outcomes should be built holistically around:

• people’s wishes and feelings;
• their needs;
• values and aspirations.

These principles apply irrespective of the extent to which the person chooses or is able to actively direct the process.

Consideration of needs should also include the extent to which the needs or a person’s other circumstances may mean that they are at risk of abuse or neglect. The planning process may bring to light new information that suggests a safeguarding issue, and therefore lead to a requirement to carry out a safeguarding enquiry (see Safeguarding Enquiries Process). Where such an enquiry leads to further specific interventions being put in place to address a safeguarding issue, these  should  be included in the care and support plan.

Each partner in the plan should be clear about their role. For example, the person may need help to weigh up different service options to understand what each involves and to be able to choose the most appropriate and least restrictive option possible.

In some circumstances it may not be appropriate to jointly prepare the plan. For example, a person may not wish their family to be involved, the authority may be aware that family members may have conflicting interests, or the person may have asked the local authority to prepare the plan with someone who lives far away from the person and even with the assistance of email, phone and other methods of communication is unable to prepare the plan in a timely fashion.

The test for allowing the person and others to prepare the plan jointly with the local authority should start with the presumption that the person at the heart of the care plan should give consent for others to do so.

Safeguarding principles must be included in order to ensure that there is no conflict of interest between the person and the third party they wish to involve to prepare the plan jointly with (see Safeguarding: What is it and Why does it Matter?)

Where a person lacks capacity and cannot consent to third parties jointly preparing the plan, the local authority must always act in the best interests of the person requiring care and support.

1. Introduction

The Care Act 2014 sets out the local authority’s functions and responsibilities for care and support. Sometimes external organisations might be better placed than the local authority to carry out some of these functions. For example, an outside organisation might specialise in carrying out assessments or care and support planning for certain disability groups, where the local authority does not have the in-house expertise.

The Care Act allows local authorities to delegate some, but not all, of their care and support functions to other parties. This power to delegate is intended to allow flexibility for local approaches to be developed in delivering care and support, and to allow local authorities to work more efficiently and innovatively and provide better quality care and support to local populations.

As with all care and support, individual wellbeing should be central to any decision to delegate a function. The local authority should not delegate its functions simply to gain efficiency where this would not benefit the wellbeing of people using care and support services.

The local authority retains ultimate responsibility for how its functions are carried out. Delegation does not remove its legal responsibilities. When a local authority delegates any of its functions, it retains ultimate responsibility for how the function is carried out. Anything done (or not done) by the third party in carrying out the function, will be treated as if it has been done (or not done) by the local authority itself. This is a core principle of allowing delegation of care and support functions.

People using care and support services will always have a means of redress against the local authority for how any of its functions are carried out. For example, a local authority might delegate needs assessments to another organisation, which has its own complaints procedure. If the adult to whom the assessment relates has a complaint about the way in which it was carried out, they can take it up with the organisation in question. However, if this does not satisfy the adult, or if they choose to complain directly to the local authority, the local authority will remain responsible for addressing the complaint.

2. Care Act Delegation Provisions

Section 79 of the Care Act 2014, provides the power for local authorities to authorise a third party to carry out certain care and support functions.

However, under Section 79(2) certain Care Act functions are excluded from this power to delegate:

• Section 3 – promoting integration with health services;
• section 7 – cooperating;
• section 14 – charges; and
• sections 42-47 – safeguarding adults of risk of abuse and neglect.

These functions therefore may not be delegated to a third party (see also Section 4, Care and Support Functions which must not be Delegated).

Section 79(4) (4) provides that that the local authority can determine the extent to which it delegates the function in any particular case. For example, a local authority may delegate the carrying out of all needs assessments to a third-party organisation, or it may choose to delegate assessments only for certain groups of people and still carry out other assessments itself. When delegating any function, the local authority can impose conditions on the way the third party exercises the function.

Section 79 (5) provides that any authorisation is only for the period specified, and the local authority may revoke the authorisation at any time during that period. Delegating the function does not prevent the local authority from being able to carry out the function itself.

Section 79 (6) sets out that any acts done (or failed to be done) by the third party in carrying out any function delegated to them are treated as done (or not done) by the local authority itself.

Section 79 (7) makes it clear that the third party cannot avoid liability for any criminal actions or for any disputes between it and the local authority arising out of any contractual relationship between them. The delegation of any function does not absolve the local authority of ultimate responsibility for ensuring the function is carried out properly and in accordance with all relevant statutory obligations.

Section 79 (8) provides for disclosure of information between the local authority and anyone to whom it has delegated a function where such disclosure is necessary for the exercise of that function. A third party may be given information by the local authority where it is necessary for the exercise of the delegated function, but the third party becomes subject to the same kind of confidentiality requirements in respect of that information as apply to the local authority.

3. Importance of Contracts

The success of a decision by a local authority to delegate its functions to a third party will be largely determined by the strength and quality of the contracts that it makes with the delegated third party.

Through the terms of its contracts with authorised third parties, the local authority has the power to impose conditions on how the function is carried out. For example, when delegating assessments, it could choose to require that assessments must be carried out by people with a particular training or expertise and that the training must be kept up to date.

The delegated organisation will be liable to the local authority for any breach of the contract,  which means the local authority can ensure that its functions are carried out properly, and hold the contractor to account.

Where a local authority uses its power to authorise another party to carry out its care and support functions, it should specify how long the authorisation lasts, and it should make clear that it may revoke the authorisation at any time during that period.

Monitoring arrangements should be put in place so the local authority can be assured that functions that have been delegated are being carried out in an appropriate manner.

Since care and support functions are public functions, they must be carried out in a way that is compatible with all of the local authority’s legal obligations. For example, the local authority will be liable for any breach by the delegated party of its legal obligations under the Human Rights Act or the Data Protection Act. The local authority should therefore draw up its contracts to ensure that third parties carry out functions in a way that is compatible with all of its legal obligations.

Although the local authority retains overall responsibility for how its functions are carried out, delegated organisations will be responsible for any criminal proceedings brought against them.

The local authority can choose the extent to which it delegates its functions. It should make clear in its contracts with authorised parties, the extent to which the function is being delegated.

The fact that a local authority delegates its functions does not mean that it cannot also continue to exercise that function itself. For example, a specialist mental health organisation can be contracted to carry out care and support planning for people with specific mental health conditions, but the local authority may choose to do care and support planning for people with other mental health conditions itself, or it may choose to offer people a choice between itself and the external organisation

4. Care and Support Functions which must not be Delegated

As noted in Section 2, Care Act Delegation Provisions, certain functions must not be delegated. These are:

• integration and cooperation: the local authority must cooperate and integrate with local partners. Delegating these functions would not be compatible with meeting its duties to work together with other agencies. However, the local authority should take steps to ensure that authorised parties cooperate with other partners, work in a way which supports integration, and is consistent with its own responsibilities;
• adult safeguarding: there is a legal framework for adult safeguarding, including the establishment of a local Safeguarding Adults Board (SAB), carrying out safeguarding adults’ reviews and making safeguarding enquiries. Since the local authority must be one of the members of SABs and it must take the lead role in adult safeguarding, it may not delegate these statutory functions to another party. However, it may commission or arrange for other parties to carry out certain related activities;
• power to charge: the Care Act gives the local authority the power to charge people for care and support in certain circumstances. Local policies relating to what can and cannot be charged should be decided by the local authority, therefore it cannot delegate this decision to outside parties. However, it may commission or arrange for other parties to carry out related activities.

5. The Difference between Delegating a Statutory Care and Support Function and Commissioning other related Activities

For those functions which may not be delegated (outlined in Section 4 Care and Support Functions which must not be Delegated), and other functions which may be delegated, the local authority may wish to use outside expertise to assist in carrying out practical activities to support it in discharging those functions, rather than fully or formally delegating the function itself to be carried out by another party.

For example, a local authority may not delegate its functions relating to establishing a Safeguarding Adults Board, making safeguarding enquiries or arranging safeguarding reviews. However, the enquiry duty is for local authorities to make enquiries or cause them to be made, so a local authority can still have arrangements whereby NHS or other organisations are asked to undertake the enquiries where necessary. So, while a local authority can ask others to carry out an actual enquiry, it cannot delegate its responsibility for ensuring that this happens and ensuring that, where necessary, any appropriate action is taken.

Another example is the local authority’s function which gives it discretion over charging people for care and support. The local authority itself must decide its charging policies. However, it may commission an external agency to carry out the administration, billing and collection of fees for care and support on its behalf. These activities are not classed as care and support functions even though they are related to the charging function

6. Section 75 Agreements

These agreements are made under Section 75 of the National Health Services Act 2006 (‘the Act’) between partners, NHS bodies and local authorities in England. They often include arrangements for pooling resources and delegating certain NHS and local authority health-related functions to the other partner/s if it would lead to an improvement in the way those functions are carried out.

The Act enables NHS bodies and local authorities to enter into arrangements under secondary legislation. The NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000 sets out details of the permitted arrangements:

• NHS bodies can carry out local authorities’ health-related functions along with their NHS functions;
• local authorities can carry out NHS functions along with their local authority health-related functions;
• NHS bodies and local authorities can establish and run a pooled fund which is made up of contributions by the partners, and out of which payments may be made towards carrying out the functions that are within the scope of the arrangements;
• such arrangements can only be formed if it is likely to lead to an improvement in the way in which the functions are exercised;
• any partnership arrangements entered into under section 75 of the Act do not affect the liability and accountability of NHS bodies or local authorities for the exercise of any of their functions (s.75(5)).

6.1 Objective of the Section 75 partnership arrangements

Partnership arrangements made under Section 75 of the Act enable NHS statutory bodies (ICBs / NHS England or NHS trusts / foundation trusts) and local authorities to collaborate across a range of local authority health-related functions and NHS health functions, permitted within the regulations. It usually includes establishing a joint committee to manage the arrangement and pooling funds to cover relevant expenditure. The arrangements should have an integrated care strategy.

6.2 Main features of Section 75 partnership arrangements

Such arrangements:

• allow health and social care commissioners to take decisions in a collaborative way and ensure that both parties implement the decisions taken. These arrangements aim to ensure that timely decisions are taken and avoid bureaucracy;
• allow a range of NHS provider health functions to be exercised collaboratively with health-related local authority functions. The following NHS services are excluded from section 75 arrangements:
• surgery, radiotherapy, termination of pregnancies, endoscopy, the use of Class 4 laser treatments and other invasive treatments;
• Section 7A public health services;
• primary dental services;
• pharmaceutical services;
• primary ophthalmic services;
• emergency ambulance services.
• tend to be managed with lead commissioner or lead provider arrangements – but they can also support joint working;
• are documented in a written agreement that details the precise scope of the functions to be exercised; that is, by the lead organisation. Partners in the arrangement should provide regular assurance that each one has the appropriate capabilities and resources to carry out the function effectively;
• allow for the creation of a pooled fund.

 7. Conflicts of Interest

There might be instances where there is the potential for a conflict of interest when delegating functions. For example, when the same external organisation carries out care and support planning, but also provides the resulting care and support that is set out in the plan. Local authorities should consider whether the delegation of its functions could give rise to any potential conflict and should avoid delegating functions where there would be an inappropriate conflict.

Local authorities should consider imposing conditions in contracts with delegated parties to mitigate against the risk of any potential conflicts. For example, care and support planning could be delegated, but the local authority would retain the final decision making, including signing off the amount of the personal budget (see Care and Support Planning and Personal Budgets chapters).

8. Conflict of Interest relating to making Direct Payments

The local authority has number of functions relating to the provision of direct payments. These functions include deciding whether someone can manage a direct payment, being satisfied that the direct payment is being used in a way that is meeting the person’s needs and monitoring this periodically. The local authority may choose to delegate these functions. For example, where an authorised external party is carrying out care and support planning, it may decide that the direct payment functions could also be delegated to that party (see Direct Payments).

The local authority can also make direct payments to people, that is, paying them money to meet their care and support needs. This function may also be delegated to an external party. However, where the local authority delegates its functions relating to assessment of needs or calculation of personal budgets to an external party, it should not allow that same party to make the direct payments. In these cases, the actual payment of money should be made directly from the local authority to the adult or carer. This is because it is not appropriate for an external party to determine both how public funds are to be spent, as well as handling and those funds. This is in line with standard anti-fraud practice.

9. The Health and Care Act 2022

The Health and Care Act 2022 came into force in August 2024. It provides for the establishment of statutory integrated care boards and statutory integrated care partnerships.

Each integrated care board and a local authority partner are required to establish an integrated care partnership. The integrated care partnership will bring together health and social care, public health and representatives from other services, such as social care providers or housing providers.

The Health and Care Act aims:

a) to promote collaborative commissioning by removing barriers and bureaucracy which have hindered delivering high-quality care to people;

1. to make it easier for integrated care boards to commission services collaboratively with other integrated care boards and other system partners by permitting a wider set of arrangements for joint commissioning, pooling of budgets and delegation of functions;
2. To promote ‘working together to improve health and social care for all’. The ‘Triple Aim’ is to cooperatively pursue:
   • better care for everyone;
   • better health and wellbeing for everyone;
   • sustainable use of NHS resources. It should facilitate the tackling of inequalities in health and wellbeing.

The previous legislative framework often led organisations to work primarily in the best interest of their own organisations and the people they immediately work with, and did not support the delivery of integrated, person-centred care.

The new duties under the Health and Care Act are:

1. organisations must think about the interests of the wider system and provide common, system-wide goals that need to be achieved through collaboration;
2. a further duty for the organisations to cooperate – the Health and Care Act introduced a new power that allows the Secretary of State to issue guidance on cooperation between NHS bodies and between NHS bodies and local authorities;
3. the new guidance should give organisations greater clarity about what the duties to cooperate mean in practice, help to build on the present working relationships and positive behaviours that had been seen during the covid pandemic period.

1. Introduction

When an adult with care and support needs is referred to the local authority because of a safeguarding concern, they must be actively involved in any safeguarding enquiry or safeguarding adult review (SAR). Under the Care Act, the local authority has a legal duty to provide independent advocacy to support adults through these processes, if they would otherwise have substantial difficulty in being involved (see Section 3.1 Substantial difficulty).

Advocacy should be seamless for adults who qualify, so that they can benefit from the support of one advocate throughout the safeguarding process. Adults who have substantial difficulty in engaging should not be expected to have to tell their story repeatedly to different advocates.

The aim of independent advocacy support is for the adult’s wishes, feelings and needs to be at the heart of the any safeguarding enquiry or SAR.

2. Local Authority Responsibilities to Provide Independent Advocacy

The local authority has a duty to arrange an independent advocate for:

• all adults, as part of their own assessment and care planning and care reviews and to those in their role as carers;
• adults who are subject to a safeguarding enquiry or SAR.

There are two conditions which also need to be met for the provision of an independent advocate. These are that:

1. if an independent advocate were not provided the adult would have substantial difficulty in being fully involved in these processes;
2. there is no appropriate person available to support and represent the adult’s wishes who is not paid or professionally engaged in providing care or treatment to them or their carer.

The role of the independent advocate is to support and represent the adult, and to facilitate their involvement in the key processes and interactions with the local authority and other organisations as required for the safeguarding enquiry or SAR.

Local authorities also provide advocates for children who are approaching the transition to adult care and support, or who are having a young carer’s assessment.

3. Advocacy and the Duty to Involve

Adults must be fully involved in decisions made about them and in any safeguarding enquiry or SAR.

The local authority must help adults to understand how they can be involved, how they can contribute and take part and, where appropriate, lead or direct the process. Adults should be active partners in any enquiries in relation to abuse or neglect. No matter how complex the adult’s needs, local authorities are required to involve them, to help them express their wishes and feelings, to support them to weigh up options, and to make their own decisions.

The advocacy duty applies to safeguarding enquiries or SARs for adults living in all settings, except prisons.

Adults who qualify for advocacy under the Care Act may also qualify for advocacy under the Mental Capacity Act (MCA) 2005. The same advocate can provide support as an advocate under the Care Act and under the MCA. Whichever legislation the advocate is acting under, they should meet the appropriate requirements for an advocate under that legislation.

3.1 Substantial difficulty

Local authorities must form a judgement about whether an adult has substantial difficulty in being involved with these processes. If it is thought that they do, and that there is no appropriate person to support and represent them the local authority must arrange for an independent advocate to support and represent the adult.

Many adults who qualify for advocacy under the Care Act will also qualify for advocacy under the Mental Capacity Act 2005 (MCA). The same advocate can provide support as an advocate under the Care Act and under the MCA. This is to enable the adult to receive seamless advocacy so that they do not have to repeat their story. Whichever legislation the advocate is acting under, they should meet the appropriate requirements for an advocate under that legislation.

3.1.1 Judging ‘substantial difficulty’ in being involved

The Care Act defines four areas in which an adult may experience substantial difficulty:

1. Understanding relevant information: Often adults can be supported to understand relevant information, if it is presented appropriately and if time is taken to explain it. Some however, will not be able to understand relevant information, for example if they have mid-stage or advanced dementia.
2. Retaining information: If the adult is unable to retain information long enough to be able to weigh up options and make decisions, then they are likely to have substantial difficulty in engaging and being involved in the process.
3. Using or weighing the information as part of engaging: The adult must be able to weigh up information, in order to participate fully and choose between options. For example, they need to be able to weigh up the advantages and disadvantages of moving into a care home or leaving an abusive relationship. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process.
4. Communicating their views, wishes and feelings: The adult must be able to communicate their views, wishes and feelings either by talking, writing, signing or any other means, to aid the decision process and to make their priorities clear. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process. For example, an adult with mid-stage or advanced dementia, significant learning disabilities, a brain injury or mental ill health may be considered to have substantial difficulty in communicating their views, wishes and feelings. The adult’s ability to communicate their views, wishes and feelings will be key to their involvement rather than the diagnosis or specific condition.

4. Advocacy Support for Safeguarding Enquiries and Safeguarding Adults Reviews (SARs)

If the adult has substantial difficult in engaging with the safeguarding enquiry process or SAR, and there is no one else appropriate who can support them (see Section 5, Identifying an Appropriate Person), the local authority must arrange for an independent advocate to support and represent them. Where an independent advocate has already been arranged under the Care Act or under the MCA 2005 then, unless inappropriate, the same advocate should be used.

Effective safeguarding is about seeking to promote the adult’s rights as well as protecting their physical safety and taking action to prevent the occurrence or reoccurrence of abuse or neglect. It involves enabling the adult to understand any risks of abuse, and the actions that they can take, or ask others to take, to reduce those risks.

If a safeguarding enquiry needs to start urgently it can begin before an advocate is appointed, but one must be appointed as soon as possible.

Advocacy is especially important in supporting adults through difficult and / or sensitive processes (whether as part of a safeguarding enquiry or a SAR). Both can feel very daunting and involve the sharing of sensitive information which may lead to difficult decisions. Adults who have been abused or neglected may be demoralised, frightened, embarrassed or upset, and the support of an independent advocate will be crucial.

5. Identifying an Appropriate Person

Identifying an appropriate person should be considered as soon as the adult’s need for an independent advocate has been identified. An appropriate person is someone who can support the adult to be involved in the decision-making process, such as a family member or friend. For someone to act as an appropriate person, they must not speak on behalf of the adult, but have the skills to maximise their involvement.

Positives to consider when family or friends as an appropriate person include:

• they know the adult best;
• they would most likely want to support the adult;
• they will likely be able to support the adult with any speaking or hearing difficulties, for example if the adult uses Makaton but has their own signs for different things.

However, family and friends:

• may not have the necessary skills to maximise the adult’s involvement in the process;
• may find it difficult to take a holistic approach and may only see what they believe is best for the adult;
• may not be wanted by the adult to act as their appropriate person as it may impact the dynamics between them;
• may find it difficult to support the adult they are in crisis and there is a conflict of interest.

When the local authority is considering whether there is an appropriate person (or persons) who can support the adult’s involvement, there are three specific considerations.

1. they cannot be someone who is already providing the adult with care or treatment in a professional capacity or on a paid basis (regardless of who employs or pays for them).  For example, the adult’s GP, nurse, key worker or care and support worker.
2. If the adult does not wish to be supported by that person and they have the mental capacity to make that decisions, or are competent to consent, their wishes should be respected. If the adult has been assessed as lacking the mental capacity to make such a decision, then the local authority must be satisfied that it is in their best interests to be supported and represented by the person. For example where an adult does not wish to be supported by a relative, perhaps because they wish to be moving towards independence from their family, then the relative cannot be considered an appropriate person .
3. The appropriate person is expected to support and represent the adult and to facilitate their involvement in the processes. Some people will not be able to fulfil this role easily, for instance:
   • a family member who lives at a distance and who only has occasional contact with the adult;
   • a spouse who also finds it difficult to understand the local authority processes;

1. • or a housebound parent.

It is not sufficient to know the adult well or to love them deeply; the role of the appropriate person is to support the adult’s active involvement with the local authority processes.

Anyone who is implicated in any enquiry into abuse or neglect or who has been judged by a SAR to have failed to prevent an abuse or neglect is not suitable to support the adult in any of the processes.

Sometimes the local authority will not know at the point of first contact or at an early stage in the process whether there is someone appropriate to assist the adult in engaging. An advocate may be appointed before it is identified that there is an appropriate person in the adult’s own network. The advocate can at that stage ‘hand over’ to the appropriate person. Alternatively, the local authority may agree with the adult, the appropriate person and the advocate that it would be best for the advocate to continue their role, though this is not a specific requirement under the legislation.

Equally, it is possible that the local authority will consider someone appropriate who may then turn out to have difficulties in supporting the adult to engage and be involved in the process. The local authority must at that point arrange for an advocate.

There may also be some cases where the local authority considers that the adult needs the support of both a family member and an advocate; perhaps because the family member can provide a lot of information but not enough support, or because while there is a close relationship, there may be a conflict of interest with the relative, for example in relation to inheritance of the home.

If the local authority is required to appoint an independent advocate as the adult does not have friends or family who can facilitate their involvement, friends or family members must still be consulted when the adult asks for this.

Where adults in the same household are involved in the safeguarding enquiry or SAR process, they may have the same advocate, if all parties agree and the local authority is satisfied that there is no conflict of interest.

6. The Role of the Independent Advocate

The advocate will decide the best way of supporting and representing the adult  they are advocating for, always taking into account the wellbeing and interests (including their views, beliefs and wishes) of the adult concerned.

Acting as an advocate for an adult who has substantial difficulty in engaging with safeguarding processes is a responsible position.

It includes:

• assisting the adult to understand what is involved in a safeguarding enquiries and SARs. It can involve advocates spending considerable time with the adult, to understand their communications needs, their wishes and feelings and their life story, and using all this to assist the adult o be involved and where possible to make decisions;
• assisting the adult to communicate their views, wishes and feelings to the staff who are carrying safeguarding enquiries or reviews;
• assisting the adult to understand their right to have their concerns about abuse taken seriously and responded to appropriately. Also assisting the adult to understand their wider rights, including their rights to liberty and family life. An adult’s rights are complemented by the local authority’s duties, for example to involve them and to meet needs in a way that is least restrictive of their rights;
• assisting the adult to challenge a decision or process made by the local authority; and where the adult cannot challenge the decision even with assistance, then to challenge it on their behalf.

6.1 Safeguarding issues

In terms of safeguarding there are some particularly important issues for advocates to address. These include assisting the adult to:

• decide what outcomes / changes they want;
• understand the behaviour of others that are abusive / neglectful;
• understand which actions of their own may expose them to  abuse or neglect;
• understand what actions that they can take to safeguard themselves;
• understand what advice and help they can expect from others, including the criminal justice system;
• understand what parts of the process are completely or partially within their control;
• explain what help they want to avoid reoccurrence and also recover from the experience.

6.2 Making representations

There will be times when an advocate will have concerns about the way the local authority has acted or a decision that has been made or outcome that is proposed. The advocate must write a report outlining their concerns for the local authority. The local authority should hold a meeting with the advocate to consider the concerns and provide a written response to the advocate following the meeting.

Where the adult does not have the mental capacity, or is not otherwise able, to challenge a decision, the advocate must challenge any decision where they believe the decision is inconsistent with the local authority’s duty to promote the adult’s wellbeing.

Where an adult has been assisted and supported and nevertheless remains unable to make their own representations or their own decisions, the independent advocate must use what information they have, to make the representations on their behalf

They must ‘advocate’ on their behalf, to put their case, to scrutinise the options, to question the plans if they do not appear to meet all eligible needs or do not meet them in a way that fits with the adult’s wishes and feelings, or are not the least restrictive of option, and to challenge local authority decisions where necessary.

The ultimate goal of this representation is to secure the adult’s rights, promote their wellbeing and ensure that their wishes are taken fully into account.

1. Introduction

Having access to good quality information and advice enables people, carers and families to take control of, and make well informed choices about, their care and support and how they will fund it. Not only does information and advice help to promote people’s wellbeing by increasing their ability to exercise choice and control, it is also a vital part of preventing or delaying people’s’ need for care and support.

The local authority has a legal duty to ‘establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers.

The local authority must ensure that information and advice services cover more than just basic information about care and support and cover a range of care and support related areas. The service should also address prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required.

Local authorities must also provide independent advocacy to assist the person’s involvement in the care and support assessment, planning and review processes where they would otherwise have substantial difficulty in understanding, retaining or using information given to them, or in communicating their views, wishes or feelings and there is nobody else who can offer this support (see Independent Advocacy chapter).

2. Complaints

See also the chapter on Complaints or Appeals in Relation to the Safeguarding Adults Process.

Information on how to complain should be available in a range of media and produced in different, user friendly formats for people with care and support needs, and their carers. They should also be advised they can nominate an advocate or representative to speak out and act on their behalf during the complaints process if they wish (see also Independent Advocacy chapter).

3. Adult Safeguarding

The local authority and its partners have a duty to help people with care and support needs, and who may be at risk of abuse or neglect as a result of those needs, keep safe. Everyone in the community should understand the importance of safeguarding and help keep people safe.

3.1 Raising concerns and keeping safe

The local authority must provide information and advice to the public about how to raise concerns about the safety or wellbeing of an adult who has care and support needs. It should also support public knowledge and awareness of different types of abuse and neglect and how to support people to keep safe. The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on the roles and responsibilities of the Safeguarding Adults Partnership.

3.2 Commissioning and partner agencies

All commissioners or providers of services in the public, voluntary or private sectors should disseminate information about these multi-agency procedures. Staff should also be familiar with their own agency’s procedures in relation to how to respond if they suspect or encounter adults who are experiencing, or at risk of, abuse or neglect. This should be incorporated in staff manuals or handbooks, detailing terms and conditions of appointment and other employment procedures so that all individual staff members are aware of their responsibilities in relation to safeguarding adults. This information should emphasise that all those who express concern will be treated seriously and will receive a positive response from their managers.

4. Who are Information and Advice Services for?

The local authority is responsible for ensuring that all adults including carers who need for information and advice about care and support can access the service.

People who are likely to need information and advice include:

• people wanting to plan for their future care and support needs;
• people who may develop care and support needs, or whose current care and support needs may increase. Under the Care Act, local authorities are expected to take action to prevent, delay and / or reduce the care and support needs for these people (see Preventing, Reducing or Delaying Needs for Care and Support);
• people who have not contacted the local authority for assessment but are likely to be in need of care and support. Local authorities are expected to take steps to identify such people and encourage them to come forward for an assessment of their needs (see also Preventing, Reducing or Delaying Needs for Care and Support);
• people who become known to the local authority (through referral, including self-referral), at first contact where an assessment of their needs is being considered;
• people who are assessed by the local authority as currently being in need of care and support. Advice and information must be offered to these people irrespective of whether they have been assessed as having eligible needs which the local authority must meet;
• people who have eligible needs for care and support which the local authority is currently meeting (whether the local authority is paying for some, all or none of the costs of meeting those needs;
• people whose care and support or support plans are being reviewed;
• family members and carers of adults with care and support needs, (or those who are likely to develop care and support needs). Local authorities are expected to have regard to the importance of identifying carers and take action to reduce their needs for support;
• people who may benefit from financial information and advice on matters concerning care and support. Local authorities must consider the importance of identifying these people, to help them understand the financial costs of their care and support and access independent financial information and advice including from regulated financial advisers and;
• care and support staff who have contact with and provide information and advice as part of their jobs.

4.1 Carers

The local authority must recognise and respond to specific requirements that carers have for both general and personal information and advice. A carer’s need for information and advice may be distinct from information and advice for the person for whom they are caring. Their needs may be covered together, in a similar way to the local authority combining an assessment of a person needing care and support with a carer’s assessment, but may be more appropriately addressed separately. This may include:

• breaks from caring;
• the health and wellbeing of carers themselves;
• caring and advice on wider family relationships;
• carers’ financial and legal issues;
• caring and employment;
• caring and education; and
• a carer’s need for advocacy.

5. Quality of Information and Advice

The local authority must ensure that there is an accessible information and advice service that meets the needs of its population. Information and advice must be open to everyone who would benefit from it.

The local authority should ensure that information supplied is clear, meaning it can be understood and acted on by those receiving it.

It should be accurate, up to date and consistent with other sources of information and advice. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained.

All reasonable efforts should be taken to ensure that the information and advice provide meets the adult’s requirements, is comprehensive and is given at an early stage.

The local authority must make sure that all relevant information is available to people so they can make the best informed decision in their particular circumstances. Leaving out or withholding information is not acceptable.

There will be some circumstances where impartial information and advice are particularly important and the local authority should consider when this may be best provided by an independent organisation, rather than by the local authority itself. This is particularly likely to be the case when people need advice about if, how and when to question or challenge the decisions of the local authority.

6. Content

The local authority must ensure that information and advice is available on:

• how the local care and support system works locally – about how the system works. This includes the assessment process, safeguarding, eligibility, and review, complaints, appeals, independent advocacy, supporting individual wellbeing charging for care and support costs, national resources, planning for future care, planning for future lack of capacity;
• how to access the care and support available locally;
• the choice and types of care and support, and the choice of care providers available in the local area – including prevention and reablement services and wider services that support wellbeing;
• how to access independent financial advice on matters relating to care and support;
• how to raise concerns about the safety or wellbeing of an adult with care and support needs (and also consider how to do the same for a carer with support needs).

Depending on local circumstances, the service should also include, information and advice on:

• housing and housing-related support options for those with care and support needs;
• treatment and support for health conditions, including Continuing Health Care arrangements;
• availability and quality of health services;
• availability of services that may help people remain independent for longer such as home improvement agencies, handyperson or maintenance services;
• availability of befriending services and other services to prevent social isolation;
• availability of intermediate care entitlements such as aids and adaptations;
• eligibility and applying for disability benefits and other types of benefits;
• availability of employment support for disabled adults;
• children’s social care services and transition to adult care and support;
• availability of carers’ services and benefits;
• sources of independent information, advice and advocacy;
• the Court of Protection, Power of Attorney and becoming a Deputy;
• the need to plan for future care costs;
• practical help with planning to meet future or current care costs;
• accessible ways and support to help people understand the different types of abuse and its prevention.

7. Opportunities to Provide Information and Advice

There are a number of direct opportunities that the local authority has to provide or signpost people to advice and information. These include:

• at first point of contact with the local authority;
• as part of a needs or carer’s assessment, including joint Continuing Healthcare assessments;
• during a period of reablement;
• around and following financial assessment;
• when considering a financial commitment such as a deferred payment agreement or top‑up agreement;
• during or following an adult safeguarding enquiry;
• when considering take up of a personal budget and/or Direct Payment;
• during the care and support planning process;
• during the review of a person’s care and support plan;
• when a person may be considering a move to another local authority area;
• at points in transition, for example when people needing care or carers under 18 become adults and the systems for support may change.

The local authority and its partners must also use wider opportunities to provide targeted information and advice at key points in people’s contact with the care and support, health and other local services. These may be at key ‘trigger points’ during a person’s life such as:

• contact with other local authority services;
• bereavement;
• hospital entry and/or discharge;
• diagnosis of health conditions – such as dementia, stroke or an acquired impairment for example;
• consideration or review of Continuing Healthcare arrangements;
• take up of power of attorney;
• applications to Court of Protection;
• application for, or review of, disability benefits such as Attendance Allowance and Personal Independence Payments, and for Carers Allowance;
• access to work interviews;
• contact with local support groups, charities, or user-led organisations including carers’ groups and disabled persons’ organisations;
• contact with or use of private care and support services, including homes care;
• change or loss of housing;
• contact with the criminal justice system;
• admission to or release from prison;
• ‘Guidance Guarantee’ in the Pensions Act 2014;
• retirement.

8. Accessibility of Information and Advice

The local authority should ensure that products and materials (in all formats) are as accessible as possible for all potential users Websites should meet specific standards such as the Web Content Accessibility Guidelines and guidance set out in Making Your Service Accessible (UK Government).

Printed products should be produced to appropriate guidelines with important materials available in easy-read, large print and languages other than English. Telephone services or face to face services should be available to people who do not have access to the internet or who need services to be delivered in another way to meet their specific needs. Local authorities should be particularly aware of the needs of individuals with complex but relatively rare conditions, such as deafblindness, and those with hidden disabilities.

Under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in a range of accessible formats or the provision of help with communication support. When a person contacts the information and advice service, they should be asked what what is the best way for information to be given to them, and how they prefer to communicate.

Information and advice should be available in a range of formats, including:

• face to face contact;
• use of social and professional contacts;
• community settings;
• advice and advocacy services;
• telephone;
• mass communications, and targeted use of leaflets, posters and so on (for example in GP surgeries);
• use of ‘free’ media such as newspaper, local radio stations, social media;
• the local authority’s own and other appropriate internet websites, including support for the self-assessment of needs;
• third party internet content and applications;
• email.

Some groups in need of information and advice about care and support may have particular requirements. These include:

• people with sensory impairments, such as visual impairment, deafblind and hearing impaired;
• people who do not have English as a first language;
• people who are socially isolated;
• people whose disabilities limit their physical mobility;
• people with learning disabilities;
• people with mental health problems.

Some people, including those with dementia, may benefit from an independent person to help them to access information and advice. From the point of first contact with, or referral to, the local authority, the provision of independent advocacy to support involvement in assessment, planning and reviews should be considered (see Independent Advocacy chapter).

1. Introduction

One of the key aims of the Care Act 2014 is that the care and support system works to actively promote wellbeing and independence, and does not just wait until people reach a crisis point before responding. Services need to intervene early to provide care and support to adults and carers, help them retain or regain their skills and independence, and prevent the development of needs and / or delay deterioration in their health and wellbeing wherever possible.

The Care and Support Statutory Guidance sets out how local authorities should go about fulfilling their responsibilities to promote wellbeing and independence. These responsibilities apply to all adults, including:

• those who do not have any current care and support needs;
• those with needs for care and support, whether their needs are eligible and / or met by the local authority or not; and
• carers.

The term ‘prevention’ covers many different types of support, services, facilities and  other resources; it can range from widescale, whole population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one adult or a particular group of adults or carers or reducing the impact of caring on a carer’s health and wellbeing.

2. Prevent, Reduce, Delay

‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention.

2.1 Prevent: primary prevention/ promoting wellbeing

These are services, facilities or resources for adults who have no current health or care and support needs, and aim to help them avoid developing care and support needs or to help carers avoid developing support needs. They are generally universal services (meaning they are available to everyone), and can include:

• providing good quality information;
• supporting safer neighbourhoods;
• promoting healthy and active lifestyles;
• reducing loneliness or isolation or;
• encouraging early discussions in families or groups about planning for the future, for example conversations about care arrangements or suitable accommodation should a family member become ill or disabled.

2.2 Reduce: secondary prevention/ early intervention

These are more targeted interventions aimed at adults who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing. Often early support can help stop an adult’s life tipping into crisis, for example helping someone with a learning disability manage their money or providing support to help a family carer so they do not become overwhelmed.

Early intervention also covers falls prevention services, adaptations to housing to improve accessibility or provide greater assistance, handyperson services, short term provision of wheelchairs and telecare services. To identify those adults most likely to benefit from these targeted services, local authorities may undertake screening or case finding, to identify those at risk of developing specific health conditions or experiencing certain events (such as strokes, or falls), or those that have needs for care and support which are not currently met by the local authority. Targeted interventions will also identify carers, including those who are taking on new caring responsibilities

2.3 Delay: tertiary prevention

These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention includes, for example the rehabilitation of people who are severely sight impaired. Local authorities must provide or arrange services, resources or facilities that maximise independence for people who already have these needs, for example, interventions such as the provision of formal care to meet a person’s needs in their own home and rehabilitation / reablement services, for example community equipment services.

Tertiary prevention services also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through short breaks / respite care, peer support groups or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others.

Prevention is not a one-off activity. For example, a change in the circumstances of an adult and / or carer may result in a change to the type of prevention activity that would be of benefit to them. Prevention can sometimes be seen as something that happens mainly at the time of (or very soon after) a diagnosis or assessment or when there has been a change in the person’s condition. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.

3. Intermediate Care and Reablement

‘Intermediate care’ is a time limited, structured programme of care to help a person to maintain or regain their ability to live independently at home.

‘Reablement’ is a type of intermediate care, which aims to help the person regain their capabilities and live independently in their own home.

There are four models of intermediate care (see Intermediate Care Guide, SCIE):

1. Bed-based services are provided in an acute hospital, community hospital, residential care home, nursing home, standalone intermediate care facility, independent sector facility, local authority facility or other bed-based settings.
2. Community-based services provide assessment and interventions to people in their own home or a care home.
3. Crisis response services are based in the community and are provided to people in their own home or a care home with the aim of avoiding hospital admissions.
4. Reablement services are based in the community and provide assessment and interventions to people in their own home or a care home. These services aim to help people recover skills and confidence to live at home and maximise their independence.

The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these have been lost due to illness or disease. Rehabilitation services can include provisions that help people gain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

‘Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support.

4. Carers and Prevention

Carers play a key role in preventing the needs for care and support for the people they care for, which is why it is important that local authorities consider how they can prevent carers from developing needs for care and support themselves. Examples of services, facilities or resources that can help to prevent, delay and reduce the needs of carers include those which help carers to:

• care effectively and safely – both for themselves and the person they are supporting, for example interventions or advice on moving and handling safely or avoiding falls in the home, or training for carers to feel confident performing basic health care tasks;
• look after their own physical and mental health and wellbeing, including developing coping mechanisms;
• make use of IT and assistive technology;
• make choices about their own lives, for example managing their caring role and paid employment;
• find support and services available in their area;
• access the advice, information and support they need including information and advice on welfare benefits, other financial information and entitlement to carers’ assessments carried out by the local authority under the Care Act 2014.

5. The Focus of Prevention

5.1 Promoting wellbeing

Local authorities must promote wellbeing (see Promoting Wellbeing chapter) and view an adult’s life holistically. This means considering the adult’s care and support needs in the context of their strengths, skills, ambitions and priorities. This should include consideration of the role a person’s family or friends can play in helping the person to meet their goals.

5.2 Developing resilience and promoting individual strength

Adults should be supported to design care and support which helps them achieve their goals. A good starting point for a discussion that helps develop resilience and promotes independence is to ask ‘what does a good life look like for you and your family and how can we work together to achieve it?’

Giving adults choice and control over the support they may need and access to the right information enables them to stay as well as possible, maintain independence and caring roles for longer.

5.3 Working in partnership to focus on prevention

When developing and delivering local approaches to prevention, the local authority will integrate its approach with that of other local partners. Preventing needs is most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.

Within the local authority, prevention of care and support needs is closely aligned to other local authority responsibilities in relation to public health, children’s services, and housing, for example. Across the local area, the role of other bodies including the local NHS (for example GPs, dentists, pharmacists, ophthalmologists etc.), welfare and benefits advisers (for example at Jobcentre Plus), the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach

Local authorities should work with different partners to identify unmet needs for different groups and coordinate shared approaches to preventing or reducing such needs, for example working with the NHS to identify carers, and working with independent providers including housing providers and the voluntary sector, who can provide local insight into changing or emerging needs beyond eligibility for publicly funded care.

5.4 Identifying those who may benefit from preventative support

Local authorities should identify and target adults who may benefit from particular types of preventative support.

There are a number of interactions and access points that could bring an adult or carer into contact with the local authority or a partner organisation and these should act as a trigger point for considering whether the provision of a preventative service or some other step is appropriate. These include:

• initial contact through a customer services centre, whether by the adult concerned or someone acting on their behalf;
• contact with a GP, community nurses, housing officers or other professionals which leads to a referral to the local authority;
• a Care Act assessment of care and support needs or a carer’s assessment for support needs, which identifies the adult or carer may benefit from a preventative service or other type of local support.

Many people with low level care and support needs will approach the voluntary sector for advice in the first instance.

There are key points in an adult’s life or in the care and support process however, where a preventative intervention may be particularly appropriate or of benefit, for example:

• following a bereavement;
• at hospital admission and or discharge;
• when a person is admitted to or released from prison;
• when a person applied for benefits such as Attendance Allowance, or Carer’s Allowance;
• through contact with/use of local support groups;
• through contact with/use of private care and support;
• when there is a change in housing.

1. Introduction

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. Throughout the Care and Support Statutory Guidance, the different chapters set out how a local authority should go about performing its care and support responsibilities. Underpinning all of these individual ‘care and support functions’ (that is, any process, activity or broader responsibility that the local authority performs) is the need to ensure that doing so focuses on the needs and goals of the person concerned.

Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.

The wellbeing principle applies in all cases where a local authority is carrying out a care and support function, or making a decision, in relation to a person. For this reason it is referred to throughout this guidance. It applies equally to adults with care and support needs and their carers.

In some specific circumstances, it also applies to children, their carers and to young carers when they are subject to transition assessments (see Transition to Adult Care and Support).

2. Definition of Wellbeing

Wellbeing is a broad concept, and it is described as relating to the following areas in particular:

• personal dignity (including treatment of the individual with respect);
• physical and mental health and emotional wellbeing;
• protection from abuse and neglect;
• control by the individual over day to day life (including over care and support provided and the way it is provided);
• participation in work, education, training or recreation;
• social and economic wellbeing;
• domestic, family and personal relationships;
• suitability of living accommodation;
• the individual’s contribution to society.

The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering ‘wellbeing’ in the round.

3. Promoting Wellbeing

Promoting wellbeing involves actively seeking improvements in aspects of wellbeing set out above when carrying out a care and support function in relation to an individual at any stage of the process, from the provision of information and advice to reviewing a care and support plan. Wellbeing covers an intentionally broad range of the aspects of a person’s life and will encompass a wide variety of specific considerations depending on the individual.

A local authority can promote a person’s wellbeing in many ways. How this happens will depend on the circumstances, including the person’s needs, goals and wishes, and how these impact on their wellbeing. There is no set approach – a local authority should consider each case on its own merits, consider what the person wants to achieve, and how the action which the local authority is taking may affect the wellbeing of the individual.

The Act therefore signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. This is the core legal entitlement for adults to care and support, establishing one clear and consistent set of duties and power for all people who need care and support.

The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. The concept of meeting needs also recognises that modern care and support can be provided in any number of ways, with new models emerging all the time, rather than the previous legislation which focuses primarily on traditional models of residential and domiciliary care.

Whenever a local authority carries out any care and support functions relating to an individual, it must act to promote wellbeing – and it should consider all of the aspects above in looking at how to meet a person’s needs and support them to achieve their desired outcomes. However, in individual cases, it is likely that some aspects of wellbeing will be more relevant to the person than others. For example, for some people the ability to engage in work or education will be a more important outcome than for others, and in these cases ‘promoting their wellbeing’ effectively may mean taking particular consideration of this aspect. Local authorities should adopt a flexible approach that allows for a focus on which aspects of wellbeing matter most to the individual concerned.

The principle of promoting wellbeing should be embedded through the local authority care and support system, but how it promotes wellbeing in practice will depend on the particular function being performed. During the assessment process, for instance, the local authority should explicitly consider the most relevant aspects of wellbeing to the individual concerned, and assess how their needs impact on them. Taking this approach will allow for the assessment to identify how care and support, or other services or resources in the local community, could help the person to achieve their outcomes. During care and support planning, when agreeing how needs are to be met, promoting the person’s wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family). To give another example, the concept of wellbeing is very important when responding to someone who self-neglects, where it will be crucial to work alongside the person, understanding how their past experiences influence current behaviour. The duty to promote wellbeing applies equally to those who, for a variety of reasons, may be difficult to engage.

The wellbeing principle applies equally to those who do not have eligible needs but come into contact with the care and support system in some other way (for example, via an assessment that does not lead to ongoing care and support) as it does to those who go on to receive care and support and have an ongoing relationship with the local authority.

It should also inform delivery of universal services provided to all people in the local population, as well as being considered when meeting eligible needs. Although the wellbeing principle applies specifically when the local authority performs an activity or task or makes a decision in relation to a person, the principle should also be considered by the local authority when it undertakes broader, strategic functions, such as planning, which are not in relation to one individual. Wellbeing should, therefore, be seen as the common theme around which care and support is built at both local and national levels.

In addition there are a number of other key principles and standards to which the local authority must have regard to when carrying out the same activities or functions:

1. The importance of beginning with the assumption that the individual is best placed to judge the individual’s wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing. Local authorities should not make assumptions as to what matters most to the person; there should be an assumption that the individual is best placed to understand the impact of their condition/s on their outcomes and wellbeing.
2. The individual’s views, wishes, feelings and beliefs. Considering the person’s views and wishes is critical to a person centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.
3. The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer (see Preventing, Reducing or Delaying Needs for Care and Support).
4. The need to ensure that decisions are made having regard to all the individual’s circumstances (and are not based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the person’s circumstances, but should in every case work to understand their individual needs and goals.
5. The importance of the individual participating as fully as possible. In decisions about them and being provided with the information and support necessary to enable the individual to participate. Care and support should be personal, and local authorities should not make decisions from which the person is excluded.
6. The importance of achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. People should be considered in the context of their families and support networks, not just as isolated individuals with needs. Local authorities should take into account the impact of an individual’s need on those who support them, and take steps to help others access information or support.
7. The need to protect people from abuse and neglect. In any activity which a local authority undertakes, it should consider how to ensure that the person is and remains protected from abuse or neglect. This is not confined only to safeguarding issues, but should be a general principle applied in every case including with those who self-neglect.
8. The need to ensure that any restriction on the individual’s rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary. For achieving the purpose for which the function is being exercised. Where the local authority has to take actions which restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary. Concerns about self-neglect do not override this principle.

All of the matters listed above must be considered in relation to every individual, when a local authority carries out a function as described in this guidance. Considering these matters should lead to an approach that looks at a person’s life holistically, considering their needs in the context of their skills, ambitions, and priorities – as well as the other people in their life and how they can support the person in meeting the outcomes they want to achieve. The focus should be on supporting people to live as independently as possible for as long as possible.

As with promoting wellbeing, the factors above will vary in their relevance and application to individuals. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. Local authorities should consider how to apply these further principles on a case by case basis. This reflects the fact that every person is different and the matters of most importance to them will accordingly vary widely.

Neither these principles nor the requirement to promote wellbeing require the local authority to undertake any particular action; the steps it takes should depend entirely on the individual’s’ circumstances. The principles as a whole are not intended to specify the activities which should take placed. Instead, their purpose is to set common expectations for how the local authority should approach and engage with people.

4. Independent Living

Although not mentioned specifically in the way that wellbeing is defined, the concept of ‘independent living’ is a core part of the wellbeing principle. Section 1 of the Care Act includes matters such as individual’s control of their day to day life, suitability of living accommodation, contribution to society – and crucially, requires local authorities to consider each person’s views, wishes, feelings and beliefs.

The wellbeing principle is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention). Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The language used in the Act is intended to be clearer, and focus on the outcomes that truly matter to people, rather than using the relatively abstract term ‘independent living’.

5. Wellbeing throughout the Care Act

Wellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting people to live as independently as possible for as long as possible.

Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people’s needs for care and support and how meeting these can help them achieve the outcomes most important to them. Where someone is unable to fully participate in these conversations and has no one to help them, local authorities will arrange for an independent advocate.

In order to ensure these conversations look at people holistically, local authorities and their partners must focus on joining up around an individual, making the person the starting point for planning, rather than what services are provided by what particular agency. The chapter on Integration, Cooperation and Partnerships sets this out in more detail.

In particular, the Care Act is designed to work in partnership with the Children and Families Act 2014, which applies to 0 to 25 year old children and young people with SEN and Disabilities. In combination, the two Acts enable areas to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. This is considered in more detail in the chapter Transition to Adult Care and Support.

Promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them. People will have an opportunity to request their local authority support in the form of a direct payment that they can then use to buy their own care and support using this information. The chapter on Information and Advice explains this in more detail.

Control also means the ability to move from one area to another or from children’s services to the adult system without fear of suddenly losing care and support. The Care Act ensures that people will be able to move to a different area without suddenly losing their care and support and provides clarity about who will be responsible for care and support in different situations. It also includes measures to help young people move to the adult care and support system, ensuring that no one finds themselves suddenly without care on turning 18.

It is not possible to promote wellbeing without establishing a basic foundation where people are safe and their care and support is on a secure footing. The Care Act puts in place a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services.

6. The Role of the Principal Social Worker in Care and Support

The purpose of this section of the guidance is to further clarify arrangements to have in place a designated principal social worker in adult care and support. Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:

• lead and oversee excellent social work practice;
• support and develop arrangements for excellent practice;
• lead the development of excellent social workers;
• support effective social work supervision and decision making;
• oversee quality assurance and improvement of social work practice;
• advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice;
• function at the strategic level of the Professional Capabilities Framework (British Association of Social Workers).

6.1 The local authority role in supporting principal social workers

All local authorities should ensure principal social workers are given the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level and are given sufficient time to carry out their role. The principal social worker should also be visible across the organisation, from elected members and senior management, through to frontline social workers, people who use services and carers. Local authorities should therefore ensure that the role is located where it can have the most impact and profile.

Whatever arrangements are agreed locally, the principal social worker should maintain close contact with the DASS and frontline practitioners and engage in some direct practice. This can take several different forms, including direct casework, co-working, undertaking practice development sessions, mentoring, etc.

The integration of health and care and support will increasingly require social workers to lead, both in their teams and across professional boundaries, particularly in the context of safeguarding, mental health and mental capacity. Organisational models of social work have traditionally focused on managerial, as opposed to professional leadership – through their direct link to practice, principal social workers can ‘bridge the gap’ between professional and managerial responsibility, to influence the delivery and development of social work practice.

6.2 Principal social workers and safeguarding

Chapter 14 of the Care and Support Statutory Guidance endorses the: ‘Making Safeguarding Personal’ approach (see Making Safeguarding Personal). This represents a fundamental shift in social work practice in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers should have a broad knowledge base on safeguarding and Making Safeguarding Personal and be confident in its application in their own and others’ work. Local authorities should, therefore, ensure that principal social workers lead on ensuring the quality and consistency of social work practice in fulfilling its safeguarding responsibilities. In particular they should have extensive knowledge of the legal and social work response options to specific cases and in general.

1. Introduction

The Care Act 2014 came into force on 1^st April 2015. The accompanying Care and Support Statutory Guidance (Department of Health and Social Care) contains detailed guidance to help local authorities implement part 1 of the Act.

The Act sets out how care and support should be provided to adults and carers, and how it will be paid for. It supports the personalisation of care services, putting adults and carers at the centre of the care and support process, and aims to make it easier for those who need to access care and support to understand why things happen in a certain way.

2. Care Act Duties and Rights

2.1 General responsibilities and universal services

Promoting wellbeing:
This principle applies to all functions under Part 1 of the Act (including care and support and safeguarding). Whenever a local authority makes a decision about an adult, it must promote the adult’s wellbeing.

Preventing, reducing or delaying needs:
Local authorities are required to ensure provision of preventative services which help prevent and / or delay development of care and support needs, or reduce such needs (including carer support needs).

Information and advice:
An information and advice service should be available to all people in the local authority area regardless of eligible care needs.

Market shaping and commissioning of adult care and support:
The Act gives local authorities a general duty to promote choice and quality in the market of local care and support providers. The local authority must ensure a range of care providers is available; shaped by demands of adults, families and carers, and that services are of high quality and meet needs and preferences of local people.

Managing provider failure:
If a provider fails, local authorities are required to temporarily meet an adult’s needs for care and support. This applies regardless of whether there is a contract in place between the provider and the local authority, if the adults affected pay for their own care, or if other local authorities had made the arrangements to provide services.

Market oversight:
The Care Quality Commission (CQC) has a duty to assess the financial sustainability of the most difficult to replace provider, and support the local authority to ensure continuity of care if providers fail.

2.2 First contact and identifying needs

Assessment:
The local authority must carry out an assessment, referred to as ‘needs assessment,’ whenever it appears an adult may have care and support needs. The Act also sets out what should happen if an adult or a carer refuses to have a needs or carer’s assessment. All assessments must be proportionate to the level of need and consider the whole family. Self-assessments must also be offered.

Carer’s assessment:
Local authorities are required to carry out an assessment (‘carer’s assessment’) where it appears a carer may have needs for support either now or in future.

Eligibility:
Following a needs assessment or carer’s assessment, the local authority will determine if a person has eligible needs. National eligibility criteria are contained in regulations, which set the minimum level of eligibility at which the local authority must meet care and support needs.

Advocacy:
The Act specifies when the local authority must arrange an independent advocate to facilitate the involvement of an adult or carer in their assessment and care and support planning or review processes.

2.3 Charging and financial assessment

Charging:
The Act gives local authorities a general power to charge for certain types of care and support if it chooses to do so.

Financial assessment:
The local authority is required to undertake a financial assessment if it chooses to charge for particular services.

Deferred payments:
Deferred payments allow adults to enter into an agreement to delay or defer paying for the care and support services they receive. This helps avoid the need to sell property or possessions.

Recovery of charges, transfer of assets:
This allows the local authority to recover as debt any sums owed, such as unpaid charges and interest.

2.4 Care and support planning

How to meet needs:
To reflect the aims of the Care Act, local authorities should take a flexible approach to meeting people’s needs.

Duty to meet needs:
The Act describes when the local authority will have a duty to meet an adult’s eligible needs for care and support.

Power to meet needs:
This provides broad power for the local authority to meet care and support needs in circumstances where a duty to meet needs (as above) does not arise. It also enables the local authority to temporarily provide care and support without first carrying out a needs assessment, where it is needed urgently.

Duty to meet carers’ needs:
There is a legal obligation for local authorities to meet carer’s needs for support.

Care and support / support plan:
The Act describes what must be included in a care and support plans (assessed adult) / support plan (carer).

Review of care and support / support plan:
This requires the local authority to keep plans under review generally, and to carry out re-assessment / review if the adult or carer’s circumstances have changed. The adult can also request a review of their plan.

Personal budget:
Under the Care Act, local authorities should provide a written personal budget to all adults (including carers) who are assessed as eligible for care and support. The amount of the personal budget should reflect the money that is needed to cover the cost of the adult’s care and support.

Direct payments:
Adults with mental capacity can request a direct payment and, where they meet the conditions set out, the local authority must provide direct payments to meet their assessed eligible needs.

2.5 Safeguarding

Adult safeguarding:
The Act sets out the local authority’s responsibility for adult safeguarding; including the responsibility to ensure enquiries into cases of abuse and neglect and establishing a Safeguarding Adults Board.

2.6 Integration and partnership working

Integration:
Under the Act, there is a duty on the local authority to carry out its care and support functions with the aim of integrating services with those provided by NHS or other health-related services.

Duty to cooperate:
The Act places a general duty on local authorities and other relevant authorities to cooperate in relation to functions relevant to care and support. There is also specific duty to cooperate where this is needed for an adult with care and support needs.

Delegation:
This provides a power for the local authority to authorise a third party to carry out certain care and support functions.

Transition from childhood:
This places a duty on the local authority to assess a child, young carer or child’s carer before their 18th birthday if they are likely to have needs once they (or the child they care for) turn 18 in order to help them plan and the assessment will be of ‘significant benefit’.

Prisoners:
The Act clarifies responsibilities for the provision of care and support for adult prisoners and people living in approved premises (including bail accommodation).

2.7 Moving between areas: inter local authority and cross border issues

Continuity of Care:
The Act clarifies roles and responsibilities when an adult, and potentially their carer, notifies a local authority that they intend to move to another local authority area.

Ordinary residence:
Ordinary residence is used to decide if a local authority is responsible for providing care and support. The Act provides a mechanism for the local authority to reclaim money spent providing care and support to an adult for whom it was not in fact responsible.

Cross border placements:
This makes provision for a person with care and support needs who is ordinarily resident in England and requires residential accommodation, to be provided with accommodation in another part of the UK. It also allows for such placements in England for people ordinarily resident in Wales, or whose care and support is provided under relevant Scottish or Northern Irish legislation. There are similar arrangements for cross border placements not involving England that is, Wales / Scotland, Scotland / Northern Ireland, and Northern Ireland / Wales.

Mental health aftercare:
The Act clarifies aftercare services provided under section 117 of the Mental Health Act 1983 to meet need arising from / related to mental disorder of person concerned.