Hampshire County Council Adult Services Department

Care of Adults with multiple Needs Procedure 12/11

HAMPSHIRE COUNTY COUNCIL ADULT SERVICES DEPARTMENT

PROCEDURE FOR THE ASSESSMENT AND PROVISION OF CARE FOR VULNERABLE ADULTS AND ADULTS WITH MULTIPLE NEEDS

1 KEY PRINCIPLES

1.1 Legal

1.1.1  All teams in Adult Services have identical responsibilities under social care legislation regardless of the fact that the departmental structure reflects different care groups.

1.1.2  Eligibility under Fair Access to Care ( FACS ) must be assessed before any care group specific criteria are considered.

1.1.3  The department’s legal duty is covered in:
NHS and Community Care Act 1990 - Assessment of needs for Community Care services:
“Where an individual appears to the Local Authority to be in need of Community Care services, and where it appears that they may provide or arrange for the provision of Community Care services for that person, then Social Services must undertake an assessment of their needs”

1.1.4  FACS guidance 2002 (LAC)13 provided a framework for Local Authorities to determine eligibility for social care. This was issued under section 7(1) of the Local Authority Social Services Act 1970 and is therefore mandatory.
Revised guidance for this Local Authority Circular was published on 25th February 2010 and states:
“Councils must not exempt any person who approaches or is referred to them for help from the process to determine eligibility for social care, regardless of their age, circumstances, apparent financial means or the nature of their needs. To this effect, councils should avoid being too rigid in their categorisation of “client groups”. Rather needs should be considered on a person-centred basis recognising both individual need and taking into account the support that the individual’s family or support networks are willing and able to provide.” (Putting People First: A whole system approach to eligibility for social care), DH 2010)

1.1.5  A full list of all the relevant legislation and Adult Services FACS guidance is documented in the CM practice manual
http://www3.hants.gov.uk/adult-services/aboutas/departmental-procedures-main/chronological-procedures/care-management.htm

1.2 Best Practice

1.2.1 All practice and decision making should focus on achieving the best outcomes for service users and carers.

1.2.2 Assessment and provision of care should be carried out within agreed timescales as described in Section 2.

1.2.3 People should have consistent and equitable access to services, and this includes assessment. Vulnerable adults who do not fall easily into care group definitions should not receive a lesser service than those whose needs are easily defined.

1.2.4 People should have access to assessment from staff who have the appropriate skills, experience and competence, relevant to their presenting needs.

1.2.5 Issues of which care group funds should not delay assessment or provision of services.

1.2.6 There is a duty to build positive partnerships in carrying out the Department’s work. This applies to both internal and external partnerships and those with service users and carers.

1.2.7 It is important to reflect a social model of care in daily decision making and avoid labelling people in terms of ’medical diagnosis.’ Assessments should be based on the degree and nature of any disability or barrier experienced by the individual concerned and its impact on their independence – (see FACS guidance in the Care Management Practice Manual).

1.2.8 Where a case needs to be transferred to another team from PAT, Out of Hours or a Hospital team, the Team Manager of that team will make a professional judgement as to which team should take the case. This judgement will be based on the presenting needs, and the way in which these impact on the individual's independence, the need for a particular skill, or the knowledge base required to work with that person. This process should also be applied where a budget commitment is required from another team.

1.3 Safeguarding/Adult Protection

1.3.1 Where there are safeguarding concerns a person is eligible under FACS criteria regardless of any other presenting needs and will remain eligible while safeguarding procedures are in place (see FACS guidance Critical and Substantial risk 4 in the Care Management Practice Manual). There is no requirement for the person to have any other eligible needs, or to be in need of any particular types of service or support, in order to establish eligibility. If the person has Mental Health needs, it is likely that the Care Programme Approach will be used to manage their care.

2 PROCESS

People come to the attention of Adult Services through various routes

e.g. Hantsdirect/PAT, hospital teams, Mental Health, Substance Misuse or Learning Disability integrated teams, either by self referral or 3rd party referral.

The following guidance applies to all teams involved in carrying out Local Authority Social Services functions

2.1  Referral and assessment

2.1.1  The first Team Manager in Adult Services or Hantsdirect to receive a contact shall take responsibility for ensuring an initial assessment is undertaken to determine whether the person appears to be in need of Community Care services and whether the person has, on the information available, needs which may be eligible under Adult Services eligibility criteria.

2.1.2  The first Team Manager in Adult Services who receives a referral must take responsibility for acting on that referral and should ensure that a response to the referral, as defined in 2.1.3, is made within 2 working days.

2.1.3  The receiving team must either:

Make the necessary arrangements to carry out a full Community Care assessment and provide services, jointly with other teams where appropriate as described below
or

Where the information gathered in the initial assessment clearly indicates that it would be more appropriate for another Care Group team to take the lead in assessment and provision of services, negotiate with the other Care Group team within the timescales set out below to undertake these tasks.

Where PAT is the receiving team, the case will be transferred to an appropriate team according to agreed protocols – e.g. from PAT to district or locality team

2.1.4  The Department has Key Performance Indicators and reporting requirements to the Department of Health which must be met with regard to completion of full assessment and provision of services. Staff in all teams, including integrated teams, therefore have responsibility to meet adult social care Key Performance Indicators.
i.e.
● Completion of assessment within 28 days of first contact
● Provision of services within 28 days of completion of assessment
This is the maximum acceptable timeframe.
All assessments should be completed and services provided as soon as possible within these timescales, having regard to urgency and risk.

2.1.5  Where a person is dealt with by the Professional Advisory Team (PAT) the PAT Manager will determine the team the case should transfer to on basis of the available information. (See Best Practice section 1.2)

2.1.6  Where a person is known to the countywide Transition Social Work Team and meets FACS criteria the Transition Team Manager will negotiate transfer to the appropriate Adult Services team.
The transfer should be agreed by the time the young person is 17 in order to facilitate transition planning. If agreement cannot be reached on the appropriate team the same timescales for dispute resolution should be used as outlined below.

2.1.7  If the range of the person’s needs are complex and expertise from another care group is required in order to achieve a comprehensive assessment of those needs, the Team Manager receiving a case must make arrangements for assessment to be carried out jointly with staff from other care groups as required.

2.1.8  All Team Managers have a responsibility to cooperate with a request for a joint assessment from another team in order to provide the range of expertise that the person may need.

2.1.9  Through good assessment, which will identify the range of a person’s eligible needs, Managers will be able to make a decision as to which care group should continue to take lead responsibility for the case.

2.1.10  This will also help to determine how any service provision should be funded including any split funding.

2.2 Funding

2.2.1 Some vulnerable adults who meet eligibility criteria for adult social care will have needs that do not easily fit into single care group criteria. In the current position of there being no ‘pooled budget’ for vulnerable adults or those with very complex needs, managers need to negotiate cooperatively and reach agreement about which team budget will fund the care provided, or how funding should be apportioned if it is agreed the costs should be divided across different care group budgets.

2.2.2 A thorough and holistic assessment will help to determine which care group will be responsible for funding any services required to meet eligible needs, and may indicate that funding should be split between different care group budgets.
NB For those adults with a formal diagnosis of Asperger’s Syndrome there is a separate protocol which provides guidance on the funding of their care (2010) http://intranet.hants.gov.uk/adult-services/as-staff-guidance/autism/protocol-aspergers.htm

2.2.3 Provision of services must not be delayed by discussions about funding.

2.2.4 If it is not agreed at the outset which budget or budgets will be responsible for funding, any services required to meet eligible needs must be provided and funded by the lead team whilst agreement about funding is reached between the relevant teams. Any funding agreement reached must be backdated to the date of commencement of the package of care agreed as a result of the assessment.

2.2.5 Decisions about funding must be made at Service/Locality Manager level, and will be agreed between the Operational Service/Locality Managers for the involved teams, based on the assessment information and the types of service and support which are most appropriate to meet the person’s eligible needs.

2.3  Roles, responsibilities and dispute resolution

2.3.1  All negotiation and decision making about which care group takes responsibility for vulnerable adults or adults with multiple needs must be made at Team Manager level or above.

2.3.2  Decisions must be made in a timely way to ensure that the department’s timescales for assessment and provision of services are met.

2.3.3  Where the Team Manager has delegated receipt of cases into the team e.g. to a ‘duty worker’, the worker must inform the Team Manager immediately if it is unclear whether that person has been appropriately referred or transferred to the team.

2.3.4  Where a Team Manager considers that it may be more appropriate for the case to be led by a different team, direct negotiation should take place with the Team Manager of that team. Agreement must be reached within 2 working days from the date the case was received by the team.

2.3.5  Where transfer to another team cannot be agreed between Team Managers within 2 working days of receipt of a case the decision must be referred to the relevant Service/Locality Managers.
Service/Locality Managers must reach an agreement within 5 working days.

2.3.6  Where agreements about lead team, joint assessment or joint funding cannot be reached between Service/Locality Managers, a decision will be sought as soon as possible from the relevant Area/Service Director. The Area/Service Directors must ensure that the person’s needs are being met while these decisions are made.

2.3.7  Appropriate records will be entered on SWIFT to reflect the progress of the case using appropriately headed profile notes. Where a team is not using Swift as their recording system, e.g. Community Mental Health Teams, this information must be recorded using their agreed systems.

2.4  Joint working

2.4.1  Every vulnerable adult or person with multiple needs will be assigned to a lead team.

2.4.2  However, cases will be managed through joint working whenever there are needs which cut across care groups.

2.4.3  Team Managers will ensure that staff are made available to support assessments, planning and reviews which explore the full range of a person’s presenting needs, and which will support good decision making about eligible needs, appropriate services and funding.

2.4.4  The allocated worker must, with support of their Team Manager, engage the expertise of other care groups during the course of ongoing work and reviews. This will ensure that the service user will benefit from the range of skills and knowledge present in teams across the Department, according to their presenting needs.

2.4.5  Any review of a case where joint funding for social care has been agreed must involve practitioners from all the relevant teams and will be arranged in a way which best meets the needs of the service user. Reviews must be carried out in accordance with FACS requirements, i.e. within 3 months of the start of a new care package or significant change to a package, and thereafter annually as a minimum. The actual review date should be set according to the complexity and level of risk identified, taking into account any risk management plan in place. Where the person is in receipt of support including provision from health and social care, a review date should be set which enables all the elements of support to be reviewed together, and will take account of the difference review requirements of the services together with FACS requirements.

2.4.6  Managers will not unilaterally change the level or proportion of funding for a package without consultation with other involved teams. A re-assessment of needs must be carried out before any changes to funding can be agreed.

2.5.  Implementation, monitoring and review of the procedure

2.5.1  Additional information will be collected through the SDS assessment process to identify service users whose needs span more than one care group. This information will be monitored and data collected on numbers of people involved.

2.5.2  An annual audit will enable the effectiveness of the procedure to be monitored, by collection of data and qualitative information.

2.5.3  The audit will also be able to examine outcomes for vulnerable adults and people with complex needs covered by this procedure to establish whether they receive assessments and services in a timely manner.

2.5.4  Adult Services will also be able to compare the costs attached to supporting this group as opposed to other service users.

2.5.5  The audit will also undertake detailed case analysis and feedback from teams in order to inform training needs.