Actions and Next Steps (Carers)

AGE UK

AGE UK info & advice service - free and confidential advice for older people and their family members and carers and local community connections.

North, West & South Dorset

Online: Age UK North South and West Dorset

Telephone: 01305 269444

East Dorset

Online: Age UK Bournemouth, Poole & East Dorset

Telephone: 01202 530530

Citizens Advice Bureau

Citizens Advice Bureau - An independent service providing free, confidential, and impartial advice to everybody.

Online: Contact Us - Citizens Advice Central Dorset (centraldorsetca.org.uk)

Telephone: 0800 144 88 48

Help and Kindness

Help and Kindness Directory - A project to Dorset that helps people find local support when they need it.

Online: Welcome to #HelpAndKindness for Dorset

Telephone: 01305 595958

Carer Support Dorset

Carer Support Dorset - Organisation to support unpaid carers access support and services to assist them in their caring role.

Online: Carer Support Dorset, Supporting Carers in Dorset

Telephone: 0800 368 8349

Mental Health

People affected by Mental health can get information, and support from advice from Dorset healthcare University NHS foundation trust.

Online: Access Mental Health Dorset (dorsethealthcare.nhs.uk)

Telephone: 0800 652 0190 or NHS 111 

Housing

First Point work alongside people aged 16+ providing hep and support to reduce homelessness.

Online: First Point DIPS - The You Trust - Dorset Integrated Prevention Services

Telephone: 0330 1232550

Sometimes it is helpful to contact a well known national organisation with a dedicated information and advice service or help-line. See: National Organisations with Information and Advice Helplines for details of some national organisations offering this service.

Some national organisations do not have dedicated information and advice services but can still provide such support upon request. See: National Contacts for Adult Care and Support for a wider range of useful national contacts for adult Care and Support.

You can also see the Financial Assessment and Charging FAQ Response Support Tool for the answers to some frequently asked questions around financial assessment, including questions relating to Disabled Facilities Grants.

Information and advice must be provided in an accessible way so that the carer for whom it is intended can best understand and make use of it.

If you feel the carer for whom the information and advice is intended will need support to understand it then you should:

1. Consider whether the carer has anyone appropriate who can help them to understand it;
2. Consider any steps that you can take to support them to understand it (for example talking through the information over the telephone or summarising it in a simpler format); and
3. Consider the benefit of independent advocacy.

When the carer making the contact requests specifically to speak to or be contacted by a particular person you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the carer is allocated to the practitioner they have requested to speak to.

You should not transfer a telephone call to a named worker if it is clear that the worker is not allocated to the carer. This will not be helpful to the worker or to the carer as they will not be speaking to the right person to resolve the contact.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If you know when the practitioner is likely to become available you should:

1. Inform the carer of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and confirming the information given to the carer about when to expect a call back;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required should the practitioner be unavailable for more than a few hours;
4. Agree with the carer what they should do if the practitioner does not make contact at the expected time; and
5. Make a proportionate record of all the above.

If it is not clear when the practitioner will become available you should:

1. Inform the carer of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and what information has been given to the carer;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required; and
4. Agree with the carer what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

When a written contact is addressed to a named worker you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the carer is allocated to the practitioner that the written contact is addressed to.

You should not transfer a written contact to a named worker if it is clear that the worker is not allocated to the carer. This will not be helpful to the worker or to the carer as they will not be dealing with the right person to resolve the contact.

Before transferring the contact you should:

1. Confirm that the practitioner the written communication is being transferred to is available within a reasonable timeframe for the action indicated by the contact, or that you have agreed with a manager how the contact will be managed;
2. Where the communication is a letter or an e-mail, whether the practitioner wishes to receive the original contact (if not this should be filed securely); and
3. Where a written response confirming the contact has been received is required or requested, agree who will provide this.

The most secure way to transfer a written contact is to send a message to the practitioner alerting them to the contact and where it can be found on the recording system.

Any original copies of e-mails must be sent via internal secure e-mail systems only and any original letters must be sent via internal postal services or secure delivery only.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If the practitioner is not available within a reasonable timeframe for the action indicated by the contact you should:

1. Leave the practitioner a message alerting them to the contact, where it can be found on the recording system and any action undertaken, including what has been agreed with the carer if contact has been made with them;
2. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required and writing any acknowledgement letter to confirm arrival of the contact;
3. When the practitioner is not available within any timeframes indicted in the written contact or for more than a few days inform the carer making the contact of this;
4. Agree with the carer what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

Whenever the outcome of a contact or referral is that the carer will be involved in any Care and Support process (including any assessment, review or Support Planning) the Local Authority has a duty under the Care Act to make an independent advocate available to the carer when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the carer would experience substantial difficulty being fully involved in the Care and Support process without support.

See: Determining Substantial Difficulty for information about how to determine substantial difficulty.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool.

The Local Authority also has a power (but not a duty) to make advocacy available in other situations on a case by case basis if it deems this appropriate and is able to do so. This could include advocacy to support a carer to understand information and advice, or advocacy to support a carer to explore possible options available to them.

An appropriate person for general representation purposes is not the same as an appropriate person for independent advocacy under the Care Act.

See: An Appropriate Other Person for information about the difference and how to establish whether there is already an appropriate person.

The role of an independent advocate appointed under the Care Act is not the same as the role of a general advocate or any other type of advocate.

An independent advocate appointed under the Care Act must both facilitate and ensure the involvement of the carer with substantial difficulty in the Care and Support process that is taking place.

For information about the ways in which an independent advocate should fulfil their role, see: The Role of an Independent Advocate.

The advocacy referral can be made at any time and should be made without delay as soon as the duty applies.

In Dorset, advocacy is provided by the South West Advocacy Network (SWAN).

For information about SWAN and to make a referrals, see: South West Advocacy Network (swanadvocacy.org.uk).

Regardless of whether or not independent advocacy is available in the local area the duty to provide it still applies. A failure to do so is a breach of this duty and of the law. It is the role of commissioners to ensure that advocacy services are in place and available when required, and it is the role of practitioners to make timely referrals to advocates to prevent unnecessary delays in the meeting of its duty.

If you are aware that advocacy support is required and is not yet available you must not proceed to carry out any Care and Support process until it is in place.

In some circumstances urgent interim measures may need to be agreed without an advocate in place in order to reduce immediate risk to the carer from inaction. However, Care and Support processes that will decide long term and important decisions must not be carried out without advocacy support.

The duty upon the Local Authority is to make independent advocacy support available to any carer who requires it. Once made available the duty is met.

If a carer decides that they do not wish to engage in the advocacy support that has been made available to them they do not have to do so, but the Local Authority must still provide it.

The Local Authority is expected under the Care Act to support the carer to understand the role of an advocate and promote its benefit to them so as to reduce the likelihood that they will not engage.

Where the Local Authority requests another person to work jointly in some way to benefit the carer with Support needs that person has a duty to co-operate with the request (unless by doing so they will be prevented from carrying out their own duties under the Care Act or other legislation).

For further information about the duty to co-operate under the Care Act, see: Co-Operation.

Any decision to request joint work should be made with the carer.

Joint work requests should be made in the manner preferred by the service, team or professional to which the request is being made. This may or may not take the form of a referral.

The request should explain clearly the nature of the joint work required and any specific skills, knowledge and competence requirements to support allocation.

When you have been asked to work jointly with another service, team or professional you should contact them to confirm your involvement and discuss the most effective way to work together. The things you should establish include:

1. The work they are doing/will be doing/have done and whether they have any information that you need to know or can use to avoid duplication
2. Whether there are opportunities to co-ordinate systems and processes and, if so how this will be managed
3. What the expectations are in terms of joint-working (for example will you be expected to carry out a joint assessment, meet with the carer together, produce joint records or just consult and share information)
4. What the anticipated outcome of the joint work is (for example on-going joint-work to monitor)
5. What does the carer with support needs know about the joint-work to be carried out (and if they don't know who and how should this be explained);
6. Who will be the primary contact for the carer to go to with any queries; and
7. Who will be responsible for communicating progress and decisions to the carer.

See: Joint Work for further practice guidance about effective joint working.

If there are likely to be delays in your commencement of joint work the person who requested the joint work will need to:

1. Consider whether to proceed with their intervention; or
2. Await your availability.

It is the responsibility of the person requesting joint work to make this decision (in agreement with the carer) and to take steps to ensure that any urgent needs for Support are met.

Under the Care Act, when a carer is already receiving Support from the Local Authority they may request a change to their Support Plan at any time and the Local Authority must consider the request. Where the request is deemed reasonable the Local Authority has a duty to review the plan.

The review is the mechanism by which the need for a revision is determined. As such, under the Care Act a Support Plan can only be revised following a review.

Where a change is requested to a plan and there is no planned review scheduled consideration should be given to arranging an unplanned review. Any review must be proportionate to the needs of the carer and undertaken in a timely way so as to reduce the risk of a crisis developing and needs not being met.

If the carer has an allocated worker this person should carry out the review, unless the review is urgent and the worker in unavailable.

Before transferring the review request you should confirm that the practitioner the review request is being transferred to is available.

If the practitioner is not available you should speak with a manager to establish whether:

1. The request should still be transferred to the allocated worker to action when they become available;
2. Alternative arrangements should be made to carry out the review.

Where the information gathered at contact suggests there has been no change in the carer's needs, and that a change to the personal budget amount is not required may be possible to complete a 'light touch' review without further allocation.

When the information gathered at contact suggests there has been a change in need or circumstance, and that a change in the personal budget amount is required any review carried out is likely to lead to a proportionate reassessment of need. Because this is a longer term intervention allocation for this should be considered.

Not everyone contacts the Local Authority in a timely way so as to allow for an assessment and exploration of options to take place prior to any initial decisions being made about the need for Support.

For example, some carers only approach the Local Authority when they are in a time of crisis, high risk or when there is a sudden or unexpected change in their Wellbeing.

In these cases there may appear to be an urgent need for support that cannot wait for an assessment or review process to be carried out.

The Care Act recognises this occurrence and gives the Local Authority powers to meet such needs without having carried out a formal assessment process.

To see what the Care Act says about meeting urgent needs without an assessment or review, see: The Power to Meet Needs.

Having the power to meet needs without an assessment or review means that the Local Authority can decide whether or not to do so, based on the available information and specific circumstances of the carer and their situation.

Under the Care Act, the Local Authority can put any interim or urgent measures in place that it deems appropriate to meet the needs of the carer and manage the situation. This can range from a small number of domiciliary care visits to a respite stay in residential accommodation.

The same legal considerations apply when meeting urgent needs as they do when meeting non-urgent needs:

1. The impact on the carer's individual wellbeing;
2. Whether any preventative service can be provided that will delay, reduce or prevent the need for Support;
3. Whether information and advice can be provided to support the carer to find their own solution, or to delay, reduce or prevent the need for Support.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Promoting Individual Wellbeing for information about the duty to promote individual wellbeing;
• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

In addition, you should be mindful that nobody has yet assessed (or reassessed) the needs of the carer and you may be relying on historical information or information from sources currently under significant strain or pressure to act. As such the information presented may or may not be an accurate reflection of the carer's needs following an assessment.

Interim support should therefore only be seen as a temporary measure to reduce risk and support the carer to a place in time where a carer's assessment can be carried out and long term options explored and agreed with them. As such, you should be cautious about providing interim Support that may be problematic to cease following assessment.

tri.x has developed a tool that can be used as required to support consistent decision making about the provision of urgent or interim support.

See: Urgent or Interim Support Decision Tool.

Wherever possible, every conversation with a carer should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the carer to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the carer and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Authority intervenes with an assessment or other support, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

1. Taking a holistic view of the carers needs in the context of their wider support network;
2. Helping the carer to understand their strengths and capabilities within the context of their situation;
3. Helping the carer to understand and explore the support available to them in the community;
4. Helping the carer to understand and explore the support available to them through other networks or services (e.g. health);
5. Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. See: Care Act Guidance on strengths-based approaches. Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

All funding requests for urgent and interim support should be made in line with local processes and requirements.

It can be difficult to make a decision about the level of funding required to meet the urgent or interim Support needs because:

1. There will be no personal budget allocated to the carer; or
2. There will be a personal budget but this will not be based on their current needs.

The Care Act does not discuss or set funding limitations in relation to the provision of any Care and Support. This includes urgent and interim Support for carers, the golden rule of the Care Act when making any funding decision is that 'the amount of funding agreed must be sufficient to meet the needs that are to be met at that time'. Decisions must also be made in a way to ensure that the carer will be satisfied the process was fair and robust.

Other than sufficiency, the factors that decision makers must consider are:

1. The views and wishes of the carer about how their needs should be met;
2. The availability of other potential options in the marketplace; and
3. The cost of available suitable services in the marketplace.

Other factors that should be considered are:

1. The complexity of the needs of the person being supported by the carer;
2. The level of risk/sense of urgency; and
3. Whether the practitioner requesting the funding has provided relevant information and advice, whether they have explored prevention services that may be appropriate and whether they have explored how the carer's own networks of support could help; and
4. Where the carer is not ordinarily resident; if they receive Support already in another Authority the nature of the Support they receive.

Decision makers should also take into account that the Local Authority is also permitted under the Care Act to consider how to balance its legal requirement to maintain universal services to the entire local population with the power to meet urgent needs. In doing so it must:

1. Not base it's decision on finances alone;
2. Consider things on a case-by-case basis; and
3. Not set arbitrary limits (fixed amounts for a particular type of need or service).

The outcome of the funding decision should be communicated to the carer at the earliest opportunity. The method of communication should reflect that requested by the carer and any specific communication needs they may have. For the purposes of the Care Act communication about the outcome of a funding decision is subject to the same requirements as the provision of information and advice, and the duty to make it accessible therefore applies equally.

Where communication is provided by telephone a follow up letter confirming the conversation and the funding decision should be sent to the person as a formal record.

When communicating the outcome you should include the following information:

1. The funding decision itself;
2. The rationale for the decision;
3. Any information and advice relating to adult Care and Support, and the prevention, delay or reduction of needs;
4. What will happen next and the timeframes involved;
5. How to complain about any aspect of the decision or proposed outcome.

Any funding decision rationale should be clearly recorded in line with local recording requirements.

The Local Authority is not required to record urgent and interim support on a Support Plan because:

1. The support is being provided under the Local Authority's powers (as opposed to duties);
2. The carer has not yet been assessed (or reassessed); and
3. There has been no decision about eligible needs.

However, the following must be clearly recorded:

1. The urgent or interim support being provided;
2. The contribution to the cost of the support being made by the Local Authority;
3. The contribution being made by the carer;
4. The duration of the support;
5. How the support will be reviewed;
6. What outcomes the support aims to achieve; and
7. The next steps, including timeframes for any assessment.

Under the Care Act the process of arranging to meet urgent and interim Support needs is the same as arranging to meet needs agreed through a non-urgent Support Planning process.

The Local Authority is permitted under the Care Act to charge any carer for Support (including Support provided on an urgent basis) unless:

1. It chooses not to; or
2. The carer has been financially assessed as having insufficient funds to contribute; or
3. The support being provided is non-chargeable (professional support, free sitting service where available).

For further information about charging for all services under the Care Act, see: Power of the Local Authority to Charge.

It is your responsibility to understand the position of the Local Authority in regards to the financial assessment of carers.

Where urgent support is provided to a carer who is not ordinarily resident contact should be made at the earliest opportunity to the Local Authority in which they live to inform them of the intention to meet an urgent need.

Remember: A carer is deemed to be ordinary resident in the area where the person they provide care for lives, even if this is not the area where they themselves live.

Where the carer is already in support of a service from the other Local Authority information should be gathered to support any decisions made about which support should be provided.

Agreement should be reached with the other Local Authority about how any urgent Support services will be monitored, when they intend to assess for eligible needs and how reimbursement of costs incurred can be sought.

tri.x has developed a tool to support decision making around ordinary residence.

See: Ordinary Residence Decision Support Tool.

See the Ordinary Residence Procedure for further information.

Where the outcome decision is for the carer's case to be allocated to an individual worker to carry out an assessment, review or further intervention this allocation should take place in a timely way so as to:

1. Avoid any unnecessary delays to the carer;
2. Reduce the risk of a deterioration in the situation; and
3. Maximise the use of measures that will prevent, delay or reduce needs.

Where there are a significant number of carers awaiting allocation for further work or assessment there should be a fair and consistent prioritisation process in place that takes into account:

1. The level of risk;
2. The level of need;
3. Current support in place and the sustainability/effectiveness of this;
4. The urgency;
5. The likelihood of deterioration in the carers ability to carry out their role; and
6. The potential for fluctuation.

An element of monitoring should be incorporated into any allocation process to ensure that you remain aware of every carer's situation and are able to respond appropriately to any changes or need to re-prioritise allocation.

The Care Act recognises that each worker (regardless of whether or not they have a professional qualification) will possess specific skills, knowledge and experience that will enable them to carry out different Care and Support functions or work with particular people well.

Because of this there is no expectation that a particular role should carry out a particular function; instead the Local Authority should allocate tasks to the most appropriate person for the job.

Allocation decisions should take into account:

1. The skills, knowledge and experience of the worker in carrying out the function or process required;
2. The skills, knowledge and experience of the worker in working with the particular needs of the carer (for example communication needs); and
3. The views and wishes of the carer themselves in relation to the skills required of the worker and who they feel would best support them.

tri.x has developed a tool that can be used as required to support allocation decisions.

See: Allocation Support Tool.