4.1.4 Care and Support Planning

Audio & Quick Read Summary

1. Introduction

This policy sets out the statutory duties placed upon Lancashire County Council in relation to the Care Act 2014, Section 1, for care and support planning following an appropriate social care assessment.

Following completion of an assessment of needs (or a carer’s assessment), an eligibility determination and a calculation of an indicative personal budget, and if the individual meets the national eligibility threshold, Lancashire County Council must undertake care and support planning to detail how these eligible needs will be met. Lancashire County Council is also under a duty to do this under section 117 of the Mental Health Act 1983.

2. Policy Aim

This policy aims to support people to maximise their strengths, capabilities, and sources of informal support to prevent, reduce and delay care and support needs.

3. Principles of Quality Care and Support Planning

The purpose of the care and support planning process is to agree how an adult’s needs should be met, and therefore how Lancashire County Council will discharge its duty, and/or its power, to do so. Care and support planning should always be done with the adult and not for them; it should always start with the identification of the adult’s wishes, feelings, values and aspirations, not just their needs, and should always consider their wellbeing in the wider context of their rights to security, liberty and family life.

Good care and support planning includes identifying the strengths, capabilities and resources already available to the adult which they can draw on to meet their needs. Formal interventions or care and support services should only be considered when these assets have been exhausted.

The “plan” can be in any format that works for the adult and creativity and flexibility is encouraged. The person should also be told of their indicative personal budget before planning (See Personal Budgets policy).

It is important that adults are given every opportunity to prepare their own plan, if they wish. Genuine involvement will aid the development of the plan, increase the likelihood that the options selected will effectively support the adult in achieving the outcomes that matter to them, and may limit disputes as people involved will be fully aware of, and have agreed to, any decisions made. Lancashire County Council may instruct an independent advocate if the adult has substantial difficulty engaging in the care and support planning process.

Lancashire County Council’s role is to ensure that the plan which is produced represents the best balance between value for money and maximisation of the adult’s outcomes and to ‘sign off’ the plan as appropriate to meet those needs and outcomes. However, it is important that the adult knows that the plan ‘belongs’ to them and that Lancashire County Council will not share it without their permission.

When the plan is completed, Lancashire County Council must give a copy of the final plan in a format that is accessible to the adult for whom the plan is intended, and to any other person they request to receive a copy, and their advocate (if they have one).

Where Lancashire County Council is required to meet needs under section 117 of the Mental Health Act 1983 staff must liaise with the relevant health team/commissioning authority prior to commissioning any support or services or if any changes are made (see also Joint Policy for the Management of Section 117 Aftercare, Reviews and Discharge).

4. Care and Support Planning

Before beginning care and support planning, it is important to check that the adult is an ordinary resident of Lancashire. It is also important to ensure the adult is aware that the duty placed on Lancashire County Council is to meet needs that are not, or cannot be met, by universal services or others, and additionally that any support provided is chargeable as per the Care Act, i.e., support is not free (although s117 aftercare under the Mental Health Act is provided free).

Lancashire County Council will look for evidence that the adult’s strengths, capabilities and sources of informal support within their network and the wider community have been used to the full before considering formal care and support services or interventions. If there is ever a change in the informal support being provided for the adult, then their care needs would be reviewed.

Throughout the care and support planning process, staff should consider issues such as mental capacity, deprivation of liberty safeguards (DoLS), protection of property, and safeguarding.

Reablement and rehabilitation services may also be offered at this time, as may equipment or adaptations. Universal services such as clubs and services run by voluntary and community organisations would also be included as would the use of ‘brokerage’ services (usually for adults who self-fund their care needs).

The adult will also be provided with options on using their personal budget and given real examples as to how they might work in their specific situation. These different options (or pathways) are: direct payments and “care managed”.

The plan will state which option is to be used, what the outcomes are and how these will be measured. It will also contain details of what contingencies are in place to cover, for example, absences, unexpected cancellations of services or informal carer’s unavailability.

The plan must clearly detail how eligible needs will be met and how the personal budget will be spent. Other options that have been offered should also be highlighted in the plan even if they have been discounted.

As part of the care and support planning process, adults can be supported to access other services that they may be entitled to that will meet their eligible needs, such as housing or benefits. Until those eligible needs are actually met, Lancashire County Council should continue to work with the adult to ensure that these services are accessed, or needs met in an alternative way.

Lancashire County Council is not under a duty to meet needs that an informal carer is providing unless the carer does not continue in their caring role. A carer’s assessment should be offered. See Carer’s Assessments policy

5. Preparing the Plan

Empowering and enabling adults to do as much of the planning as they are able to themselves is preferred wherever possible. This is sometimes called “DIY planning”. Lancashire County Council offer adults a range of options and assistance in developing and completing their care and support plan. This assistance is tailored to their capacity and needs. The adult may also receive assistance to prepare their plan from carers, friends, and relatives (and in the absence of these should be offered an independent advocate). Adults must also be made aware of the different options available to them such as care managed or direct payments.

If a direct payment is chosen the Direct Payments policy will be followed, and the adult will be referred to the direct payments advice service for support with all aspects of budgeting and employing staff.

The length and style of plans will vary depending on the adult’s approach, needs and wishes, but each plan should be in a format that works for them.

5.1 What to include in a care and support plan

Care and Support plans should include as a minimum:

• Evidence of how the adult’s existing strengths, capabilities and resources available within their network of support are being drawn upon to meet their assessed needs. This should be the starting point, and formal interventions or services should only be considered when these assets have been exhausted.
• The adult’s needs — both eligible and ineligible – as identified in the assessment.
• The estimated and actual budget.
• Any associated risks and the management of these risks.
• The desired outcomes of service provision, the timescale for implementation, how they service provision will be measured and how frequently progress towards these outcomes will be reviewed.
• Contingency plans and emergency contacts.
• Details of how identified outcomes will be achieved. This will include specific details of the different care options which have been considered, their associated estimated costs, and the rationale behind any decision to include or reject these options in the final care plan, in relation to the adult’s stated wishes and identified outcomes.
• Details of other services that the adult receives to meet their needs e.g. NHS funding, education, or as part of the benefit system.
• The associated costs, any charges the adult has been assessed to pay, and how they wish to receive their personal budget.
• If a direct payment is offered, a detailed breakdown of all intended spending and on-costs.
• If there is a carer: their wishes around providing care, work, education and recreation. Contributions, financial or otherwise, that carers and others have undertaken to make.
• How significant changes in the care and support plan will be notified.
• The mechanism for managing or delegating control of the care and support plan.
• At review – who would be best placed to undertake this and when? The plan should maximise the adult’s choice and control while at the same time keeping them healthy, safe and well.

The plan should provide value for money. Lancashire County Council has a statutory duty to ensure that social care funds are used effectively and in accordance with the principle of best value. Lancashire County Council will ensure that the measures proposed in the care and support plan represent an effective use of the personal budget in relation to the adult’s needs and desired support outcomes. Lancashire County Council will look for evidence that the adult’s strengths, capabilities and sources of informal support within their network and the wider community have been used to the full before considering formal care and support services or interventions.

Any activity, item or service that can be legally purchased with the budget can form part of the plan as long as it meets the established objectives. Illegal items are not acceptable components of a plan. Similarly, Lancashire County Council cannot arrange services that are the responsibility of the NHS (e.g. care provided by registered nurses and services that the NHS has to provide because the individual is eligible for NHS Continuing Healthcare).

There are a number of considerations taken into account when drafting a plan:

• If a plan meets the adult’s assessed eligible needs within the available budget without endangering their health or wellbeing, then the plan should be approved.
• Positive risk-taking practice and a risk assessment should be considered if required.
• The actual budget required may be less than the estimated budget, in which case it is the lower budget that becomes the actual Personal Budget.
• If, during assessment, the carer has identified a need for respite and this relates to a need for short breaks, then this must also be included in the adult’s plan and estimated Personal Budget and agreed budget.
• If the adult is saving up/ banking towards meeting a specific variation/ need, this should be specified within the care and support plan, along with any contingency planning.
• If the needs that meet the national eligibility criteria are met, but only with spending that is outside the estimated budget allocation, this would be considered via the agreed delegation policies on a case-by-case basis.
• Whether the plan addresses all of Lancashire County Council’s statutory obligations.
• The plan must also identify measurable and specific scope for progression and how this will change or reduce the need for support in future.

5.2 Managing risk

The plan should be designed flexibly, balancing Lancashire County Council’s duty of care with its responsibility to manage risk appropriately while encouraging innovative ways to use personal budgets to achieve overall objectives. How actual or perceived risk will be managed will be specified within the plan.

An adult who has mental capacity should be supported to make informed choices as to the element of acceptable risk that they wish to accept. The plan should also include a contingency to discuss what should happen if a predictable anticipated risk could take place (e.g. an informal carer being rushed to hospital). The three governing principles for effective risk management, are:

• Adults have the right to live their lives to the full as long as that doesn’t stop others from doing the same.
• Acknowledge that there will always be some risk, and that trying to remove it altogether can outweigh the quality-of-life benefits for the adult.
• Continue existing arrangements for safeguarding adults.

5.3 Involving an advocate

An independent advocate must be provided if there is no one else in the adult’s informal network who can facilitate their involvement AND if the adult would, without the representation and support of an independent advocate, experience substantial difficulty in any of the following:

• Understanding relevant information.
• Retaining that information.
• Using or weighing that information as part of the process of being involved.
• Communicating their views, wishes or feelings (whether by talking, using sign language, or any other means).

Adults should be assumed to have the mental capacity to consent and make their own decisions unless there is evidence to the contrary. If Lancashire County Council thinks a person may lack mental capacity to make a decision or a plan, even after they have offered them all practicable support, an assessor will  carry out a mental capacity assessment in relation to the specific decision to be made.

Where an adult has been assessed as lacking mental capacity to make a particular decision, then Lancashire County Council must commence support planning under the ‘best interest principle’ within the meaning of the Mental Capacity Act.

5.4 Combining plans

Plans should have regard to all of the adult’s needs and outcomes, rather than just their care and support needs. Lancashire County Council should at establish where other plans are present, or are being conducted, and seek to combine plans, if appropriate.

One key area where plans can be combined are cases where the adult is receiving adult social care and support from Lancashire County Council and health care from the NHS. It could also be combined with the plans of carers, or other family members or with Education, Health and Care plans (for children and young people).

Consideration should also be given to how plans could be combined where budgets are pooled, either with adults in the same household, or between members of a community with similar care needs. Where it has been agreed to combine the plan with plans relating to other people, it is important that the individual aspects of each person’s plan are not lost in the process of combining plans. The combined plan should reflect the individual needs and circumstance for each person involved.

6. Sign off and Dealing with Disputes

While there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion, proportionate to the needs to be met.

Sign off should occur when the adult, their representative (if involved). an advocate (if involved) and the relevant social care worker have agreed the details of the plan, including the final personal budget amount (which may have been subject to change during the planning process) and how precisely the needs in question will be met. Lancashire County Council will take all reasonable steps to reach agreement with the adult for whom the plan is being prepared.

In the event that the plan cannot be agreed with the adult, or any other person involved, Lancashire County Council will revisit the earlier planning process and take into account the views of all parties, including providers (if involved). However, if a dispute remains and all reasonable steps to address the situation have been taken, Lancashire County Council will state the reasons for the dispute and the plan will be signed off.

The adult should be directed to the Complaints Procedure. The adult must not be left without support while a dispute is being resolved and Lancashire County Council should provide the services it considers necessary and appropriate until the complaint has been addressed.

7. Further Reading

7.1 Relevant chapters

Providing Culturally Appropriate Care 

Preventing, Reducing or Delaying Needs

Review of Care and Support Plans

7.2 Relevant information

Chapter 10, Care and Support Planning, Care and Support Statutory Guidance (Department of Health and Social Care)