Actions following a Support Plan Review (Carers)

Under Section 27 of the Care Act 2014, the local authority must keep Support Plans under periodic review. This means they must have a system or process in place to ensure that reviews are carried out and monitored in a manner appropriate to the needs and circumstances of the carer whose plan it is.

Because every carer is different, the Care Act does not specify the frequency in which a Support Plan review must take place. That said, the statutory guidance does expect the local authority to endeavour to carry out a Support Plan review as follows:

1. A review of a new service or Support Plan should be carried out within 6-8 weeks of the service/change commencing;
2. A review of an ongoing stable Support Plan should take place no less than 12 months after the date of the 6-8 week review, and then no less than once every 12 months after that;
3. Where the carer's needs or circumstances are likely to change, reviews should be arranged as required to monitor the situation and respond to changes in a timely way (thus keeping the plan under review).

Note: If the carer is in receipt of a Direct Payment, statutory timeframes for review of the Direct Payment do apply. Wherever possible, Support Plan reviews should always be aligned with Direct Payment reviews to reduce duplication for both the carer and the local authority.

Decisions about the timeframe for review must consider:

1. the complexity of the needs being met by the plan;
2. the likelihood of deterioration or improvement in the cared for person's needs or circumstances;
3. the likelihood of deterioration or improvement in the carer's needs or circumstances;
4. the complexity of the plan itself (for example, the level of ongoing involvement required to manage the plan);
5. the level of ongoing risk to the carer and the person being cared for (from fluctuating needs or abuse and neglect);
6. the risk that the plan will breakdown; and
7. whether any ongoing monitoring activity is planned in between scheduled reviews.

Decisions about the timeframe for review must have regard for:

1. the views of the carer about the timeframe for review;
2. the views of anyone else involved in the Support Plan; and
3. the impact on the carer's wellbeing of the timeframe proposed.

If you are unclear about an appropriate timeframe for review, you should seek the advice of your line manager.

If the carer is not happy with the timeframe for review that has been decided, you must make them aware of their right to complain.

The agreed timeframe for the next review should be clearly recorded on the review record and the Support Plan.

Where a short timeframe has been agreed you should record the rationale for this, especially if another person or team may be asked to carry out the next review.

Where you are making arrangements for someone else to carry out the next review (rather than carrying it out yourself), you must make sure that you have recorded this in a way that will ensure the review takes place at the agreed time.

You must let the carer with support needs know how they (or anyone else) can request an unplanned review outside of the agreed timescale if:

1. the Support Plan is not working as intended;
2. their circumstances change (for example, they are offered employment);
3. the plan is affected by any change in the circumstances of any informal support the carer receives (for example, if a family member is able to provide more or less support to the carer than anticipated in the plan).

Whenever you revise a Support Plan you should refer to the various sections of the Support Planning procedure as required, facilitating an effective conversation.

Changes to a Support Plan are only proposed changes until they have been signed off by an authoriser.

Whenever you revise a Support Plan, you should also consider the need to revise any Care and Support Plan at the same time.

A change in the method of managing the personal budget should be considered whenever:

1. the carer requests it;
2. the Local Authority identifies a different method of managing the budget as more appropriate (to meet needs, outcomes or promote wellbeing); or
3. there are issues with the current method of managing the budget (for example, misuse of a Direct Payment).

Promoting Direct Payments

The Care Act expects you to promote the use of Direct Payments. This means that whenever you identify that a Direct Payment may be an appropriate way to manage all (or part) of a personal budget, you should discuss the benefits of doing so and support access to a Direct Payment.

See the Direct Payments Procedure for further guidance.

Ending, varying, suspending or arranging a Direct Payment

All Direct Payments should be ended, varied, suspended or arranged in line with local processes and requirements.

You must end a Direct Payment agreement if the carer becomes subject to a requirement, license or order to undergo drug or alcohol rehabilitation, behaviour therapy or testing.

You should consider ending a Direct Payment if any of the following situations apply and no resolution to continue the Direct Payment can be found:

1. The person managing the Direct Payment has breached a condition of the Direct Payment Agreement;
2. The person managing the Direct Payment has not been using the Direct Payment to meet eligible needs;
3. A Direct Payment is no longer deemed the most effective way to meet the carer's needs.

See the Direct Payments procedure for further guidance.

Ending or arranging an Individual Service Fund (ISF)

All individual service funds should be ended or arranged in line with local processes and requirements.

See the Individual Service Fund procedure for further guidance.

When a decision has been made during the review to change the provider of formal services, you should use the 'Processes for Arranging All Support and Services' section to end current services and arrange a new one.

Concerns about a provider

If the current service is being ended because you have concerns about the provider, you have a responsibility to:

1. take any appropriate action under safeguarding; and
2. raise general concerns.

See: Safeguarding adults

See also: Section 13, Reporting concerns about a Service Provider

Examples of changes in circumstance that decrease a personal budget

1. Another family member intends to provide increased levels of care (reducing the carer's need for support);
2. The cared for person is going to receive increased formal services;
3. There is going to be a change in support provision and the cost of this is less than the current provision;
4. Some needs are going to be met by an alternative provision, such as health or housing.

Examples of changes in circumstances that do not change the personal budget

1. The carer will be changing the days that they receive support due to a change in working pattern;
2. The person being cared for has increased needs but other family members will be providing additional support to the carer;
3. The carer has new outcomes that existing services will be supporting them to meet;
4. A new contingency plan within the same budget has been agreed.

Examples of changes in circumstance that increase the personal budget

1. The service provider supporting the carer has failed and the only appropriate alternative has an increased cost;
2. The needs of the carer have not changed but informal support they have from family has decreased.

You must revise the Support Plan so that all of the changes being proposed are reflected in it. The date of the next planned review should also be clearly recorded.

The plan should then be submitted for sign off.

See: Carers Personal Budget Sign Off Process for further guidance.

When signed off, the updated Support Plan must be provided to the carer.

If the carer consents, a copy of the plan should also be shared with any service provider who will be responsible for providing support to the carer.

A copy must also be shared with anyone that the carer requests you share a copy with, even if they were not involved in the planning process itself.

The carer may only request that the Support Plan is ended in the following situations:

1. When all eligible needs are to be met through informal support networks and/or alternative services outside of a personal budget (for example, health provision); or
2. If applicable, the carer has become self-funding and intends to arrange and manage their own services without involvement of the Local Authority.

Any request to end the Support Plan in these situations should be considered but should only be agreed if you are satisfied that:

1. informal networks of support are appropriate, willing and able to meet eligible needs and sustainable without the plan; and/or
2. alternative services proposed are appropriate to meet eligible needs; and
3. the alternative services are available; and
4. the carer is not a vulnerable adult themselves and at risk of abuse or neglect without the plan.

In addition, there may be a benefit in maintaining the Support Plan with the carer's consent when:

1. circumstances are likely to change or deteriorate without ongoing Local Authority involvement;
2. risks to the carer or the cared for person are likely to increase without ongoing Local Authority involvement.

If you are at all concerned about ending the plan, you should discuss the benefit in maintaining the plan with the carer, although you are only able to continue the plan if:

1. the carer consents to continuing the plan; or
2. the carer is a vulnerable adult themselves and at risk of abuse or neglect without the plan.

If the plan continues, you will need to consider any revisions that are required to it, in particular:

1. changes to the support to meet eligible needs;
2. changes to the personal budget and the way that it is managed; and
3. changes to the contingency plan to manage risk.

The Local Authority can only consider ending the plan when:

1. the carer no longer has eligible needs; or
2. the person being cared for has moved into a care home on a permanent basis.

If a carer has eligible needs and the decision is made to end the Support Plan, the duty for the Local Authority to meet eligible needs is not discharged until:

1. alternative support is in place; and
2. alternative support is meeting eligible needs.

You will therefore need to consider any support that the carer may need, in order to arrange alternative services. This could involve:

1. supporting the carer directly to arrange an alternative service;
2. monitoring when the carer has arranged the service themselves;
3. liaising with another person to do so (for example, a family member or an advocate).

When alternative support is arranged, you can end the support that was being provided by the Local Authority. This could be a staged approach to terminating services, in line with the time that different alternative services begin, or an all-encompassing approach with a clear end date for all support.

Ending the financial contribution

Where applicable, and if a carer is making a financial contribution, whenever chargeable services are no longer provided through a personal budget, you must notify the team responsible for financial assessment so that arrangements can be made to:

1. cancel any financial contributions after the date that services ended; and
2. reimburse any monies that may be owing to the carer.

You can end the Support Plan itself when you are satisfied that:

1. alternative support is in place;
2. eligible needs are being met; and
3. the services provided by the Local Authority have ended.

Upon ending the Support Plan you must:

1. provide the carer with any information and advice they request (or you feel would be beneficial) about available appropriate services to meet their needs;
2. provide them with information and advice about ways they can prevent, reduce or delay needs;
3. provide them with any other information that they request or that you feel will be beneficial;
4. consider the support the carer may need to contingency plan;
5. explain to them what they should do if the alternative support breaks down in the future;
6. agree any monitoring arrangements you deem necessary;
7. explain to them what to do if they change their mind about arranging their own services (where a person has requested the Support Plan is ended);
8. explain to them what they should do if their needs or situation changes (for example, if the needs of the cared for person increase); and
9. continue to carry out any Care and Support processes with the cared for person as agreed.

All of the above information should be confirmed in writing.

You should consider closing the case when:

1. the Support Plan is ended;
2. there is no need to monitor the situation; and
3. the carer knows what to do should their circumstances change or they no longer wish to arrange their own services.

The Care Act requires you to make proportionate and appropriate arrangements to monitor the Support Plan whenever this is required.

Examples of situations when monitoring may be required include:

1. if the plan is deemed unstable even with contingency;
2. if the carer's needs are expected to change in the short term (impacting on the level of support they will need);
3. if there is a likely risk of deterioration in needs or circumstance without monitoring;
4. as part of ongoing MDT involvement or monitoring of a Care and Support Plan for the cared for person;
5. if you are co-ordinating the follow up of an action plan agreed at review;
6. to manage the risk from abuse or neglect.

The arrangements to monitor must be:

1. proportionate and appropriate to the carer's situation and risk;
2. agreed with the carer; and
3. agreed from a strengths-based approach to promote resilience of the carer and their informal networks of support.

If you are unclear about the need to monitor, you should seek advice from your line manager.

Recording monitoring arrangements

Monitoring arrangements must be clearly recorded.

Where you are making arrangements for someone else to monitor the situation (rather than monitoring it yourself), you must make sure that you have recorded this in a way that will ensure the monitoring activity takes place at the agreed time.

Monitoring should take place as agreed unless:

1. there is a need to revise the monitoring arrangements (due to an unexpected change in need or situation);
2. there is a need to carry out a different care and support function (for example, a reassessment); or
3. monitoring is no longer proportionate or necessary.

Any monitoring activity carried out should be clearly recorded and you should use supervision effectively to discuss and agree the need for continued monitoring.

When reducing or ending monitoring activity, you should do this with regard for:

1. the carer's views about the need to monitor;
2. the impact on the carer's wellbeing of any decision (including their personal resilience); and
3. any impact on the wellbeing of the person being cared for.

Future reviews

Where monitoring of a Support Plan is ongoing, consideration should be given to any subsequent statutory reviews being 'light touch' in nature.

If monitoring is no longer appropriate or required, you should:

1. ensure that a statutory review date is agreed and clearly recorded;
2. explain to the carer what steps to take should their needs or situation change;
3. provide any information and advice as required; and
4. cease monitoring activity.

If you are unclear about the need to monitor, you should seek advice from your line manager.

If the carer is not happy with any decision to reduce or end monitoring arrangements, you must make them aware of their right to complain.

Under section 5 of the Care Act, the Local Authority has a duty to maintain an effective and efficient market of services for meeting care and support / support needs in the local area. A key part of maintaining a marketplace is understanding what is working and not working about the marketplace. It is, therefore, important that you report any concerns you have about any service that is provided to meet care and support / support needs to the service within the Local Authority responsible for monitoring it.

The local marketplace includes:

1. services that are commissioned by the Local Authority;
2. services that are provided by the Local Authority (for example, Reablement);
3. services used by self-funders and people who have a Direct Payment;
4. universal services available to all residents; and
5. services provided by partner agencies (for example, Health or voluntary services).

A Contract Management Framework has been introduced to enable the Commercial Team to assess the services commissioned and monitor the quality of care delivered. Therefore, it is important that Contract Officers gather as much information as possible to continually evaluate the standard and quality of care provided. Contract Officers work in teams to provide a Lincolnshire wide service, to include:

1. Strategic;
2. Residential;
3. Home Care; and
4. Specialist Services.

Working to promote closer working relationships with area teams and Health colleagues, to effectively monitor care delivery and to ensure information is shared in a timely manner, to promote better outcomes for people.

Any Adult Care practitioners visiting a provider or a person are invited to provide feedback on a range of issues including care plans, the environment/setting and staffing matters using the Poor Practice Form.  Contract Officers will also use these forms to analyse any trends in information.

See: Poor Practice Concern Form available in the Local Resource Library under Safeguarding.

When completed, please return the form to poorpracticeconcerns@lincolnshire.gov.uk.

Where you are providing details about a particular incident involving a person with care and support needs, you should:

1. make the person aware that you are raising the concern and why; and
2. establish whether they consent to being contacted as part of any further information gathering, if required.

There is also a series of questions in the ‘Adult My Review – Person Data Form’ where practitioners, following a visit and discussion with the person, are to rate the effectiveness of the commissioned service in meeting the needs of the person for categories such as overall service delivery, provider care plans and environment. There is also a text box to record specific feedback.

In all cases, you must take appropriate steps to manage the risk to an individual posed by the poor practices of a service provider. Effective ways of managing the risk could be:

1. raising a Safeguarding concern;
2. arranging an alternative provider (there is a duty to do this when a regulated provider fails);
3. agreeing monitoring arrangements.

The Commercial Team will determine the most appropriate response to the concern that has been raised, which could include:

1. contract renegotiation with a commissioned provider;
2. agreeing and monitoring an action plan with the provider;
3. a temporary stop on the use of a provider;
4. a large scale safeguarding response;
5. joint work with another Local Authority (when the provider is not local);
6. a recommendation to information and advice services not to signpost to a provider;
7. notification of concerns to the Care Quality Commission;
8. a letter to people who use a service.

You may be asked to support the Commercial Team by providing additional information or assisting in any investigation process they undertake. You are required to co-operate with any request under the Care Act unless doing so will:

1. prevent you from effectively carrying out other duties under the Care Act; or
2. prevent you from effectively carrying out duties under any other legislation.

If the services are provided by a partner organisation (such as Health, Housing or Education) there will be local arrangements in place to report concerns. If you do not know what these arrangements are, you should:

1. speak to your line manager; or
2. speak to the Commercial Team.

Where you are providing details about a particular incident involving a carer or person with care and support needs, you should:

1. make the individual aware that you are raising the concern and why; and
2. establish whether they consent to being contacted as part of any further information gathering if required.

When concerns arise about the practice of a personal assistant, you should discuss your concerns with:

1. the person with care and support needs (or their representative if they lack capacity);
2. the carer; and
3. the person receiving the Direct Payment (if this is not the person or the carer).

Depending on the nature of the concern, it could be resolved through:

1. a conversation with the personal assistant to discuss the concerns and identify action required to resolve them;
2. the provision of training to the personal assistant (for example, manual handling training);
3. a review of the working conditions and requirements in the contract to make sure that the tasks to be completed are clear.

If specialist information or advice is required or requested (for example, relating to employment law), advise the carer to contact a suitably qualified person or organisation as required.

If presenting issues cannot be resolved, or you remain concerned about the continued suitability of the personal assistant, you should consider:

1. any monitoring arrangements required;
2. the need to add a condition to the Direct Payment, that the Direct Payment cannot be used to employ the personal assistant; or
3. the need to end the Direct Payment.

Any decision must have regard for:

1. the views of the person with care and support needs;
2. the views of the carer;
3. the views of the person receiving the Direct Payment (if this is not the person with care and support needs); and
4. the impact on the person's wellbeing.

You should seek the advice of your line manager and the team responsible for managing Direct Payments as required.

Concerns about a personal assistant providing support to others

If you know that the personal assistant is providing care and support to other individuals in the local area, you must consider any further action required. This could be:

1. notifying the team responsible for managing Direct Payments of the concerns so they can take appropriate action to notify others;
2. raising a safeguarding concern in respect of another individual being supported by the personal assistant.

Concerns about a personal assistant who is part of a local register

When a personal assistant is part of a local register of PAs, it is important that any unresolved or ongoing concerns are reported to the organisation or person responsible for managing the register.

This will allow for the register to be updated and consideration given to the ongoing suitability of the PA to be included on it.

The Local Authority values openness, transparency and candour, and encourages you to raise concerns as soon as possible about the practice of any individuals (whether they are employed by the Local Authority or not) that you feel:

1. compromises the safety or wellbeing of a person with care and support needs; and/or
2. compromises the safety or wellbeing of a carer with support needs; and/or
3. compromises the safety of a child.

Examples of individuals employed by the Local Authority include:

1. a social worker;
2. an occupational therapist;
3. unqualified workers in social work or occupational therapy services;
4. support workers in Local Authority day or provider services;
5. individuals employed in other areas of the organisation (such as Housing Officers and Teachers in Local Authority schools or colleges).

Examples of individuals employed by other organisations include:

1. Health professionals (for example, a community or District Nurse, a GP, a Psychiatrist or Psychologist, a Speech and Language Therapist, an Optician, or a Dentist);
2. Police Officers;
3. a support worker in a charitable organisation;
4. an advocate.

Whistleblowing is part of the Public Interest Disclosure Act 1998 (PIDA). Under the Act you:

1. must be provided with a safe space in which to raise the concerns;
2. must be taken seriously;
3. cannot be subjected to any detrimental or unfavourable treatment and victimisation by the Local Authority, or individuals, as a result of making a disclosure.

Legally you do not have to provide any hard evidence to support a whistleblowing disclosure but, if you have any evidence, you should always provide it. This could be:

1. details of when a specific incident occurred;
2. a witness statement written by you or that has been provided to you;
3. other documentary evidence (for example, an e-mail or letter).

If you require further advice about whistleblowing before making a disclosure, you can contact the Whistleblowing Helpline:

1. by telephone on 08000 724 725;
2. by e-mail at enquiries@wbhelpline.org.uk.

Concerns should be raised in line with local whistleblowing policy and process.

See. Whistleblowing policy – Introduction and scope - Lincolnshire County Council