8.2 Continuity of Care

1. Introduction

This policy sets out how Lancashire County Council will meet its statutory duties under Sections 37-38 of the Care Act 2014 to ensure continuity of care for adults who wish to move to another local authority area within England.

2. Policy Aim

This policy aims to ensure that an adult with care and support needs will be able to move with the confidence that arrangements to meet their needs will be in place on the day of the move. This means ensuring that the authority to which the person is moving has completed a needs assessment and developed a care and support plan for the adult prior to the day of the move

3. The Legal Framework

Just like anyone else, adults with care and support needs may decide to move home.

Where adults do decide to move to a new area and, as a result, their ordinary residence status changes it is important to ensure that care and support is in place during the move, so the person’s wellbeing is maintained.  See Ordinary Residence policy for more information.

Where an adult who is receiving support from Lancashire County Council moves to a new home within the Lancashire area, they will remain ordinarily resident within the Lancashire County Council area. Lancashire County Council must continue to meet their needs.

Where the adult chooses to live in a different council area, the local authority that is currently arranging care and support (the “first authority”) and the authority to which they are moving (known as the “second authority”) must work together to ensure that there is no interruption to the person’s care and support.

In some cases, Lancashire County Council will be the first authority; at other times Lancashire County Council will be the second authority – depending on whether the person concerned is moving into or away from the Lancashire County Council area.

This means that Lancashire County Council must work with other local authorities both when adults it supports move to another area, and when an adult moves into the Lancashire County Council area from another area.

Lancashire County Council will contact the second authority as soon as possible upon notification of the adult’s intention to move to that local authority area.  The timescales within which Lancashire County Council will notify and work with a second authority or would expect to be notified and work with a first authority will be determined by the proposed date of the move.

It is possible that the second local authority might be unable to complete a needs assessment prior to the day of the move due to the logistics of assessing a person a long distance away, or because they want to assess the adult in their new home. If the second authority has not carried out the assessment prior to the move, it must continue to meet the person’s needs and take into account outcomes identified in their current care and support plan until it has carried out its own assessment.

The best way to make sure that an adult’s care continues is to work closely with other local authorities and to put the adult (and their carer, if they are continuing to care for the adult) at the centre of the process.

4. Making an Informed Choice

When considering the possibility of moving, you may want to find out information about the care and support available in one or more different local authorities. Local authorities already make much of this information publicly available in accordance with its general duties under the Care Act, and they should provide any extra information requested by you and, where relevant, your carer.

Lancashire County Council will provide you and your carer with relevant information or advice to help inform your decision. For example, advice on the implications for your care and support (and your carer’s support) can be provided, but the final decision on whether or not to move is for you and, if relevant, your carer to make (unless Lancashire County Council has concerns about your ability to make an informed decisions and/or there are safeguarding concerns).

5. Confirming the Intention to Move

The continuity of care process starts when Lancashire County Council is notified of your intention to move. Lancashire County Council may find out about your intention to move from you directly or through someone acting on your behalf, or from the authority from which you are moving. In any instance, Lancashire County Council must assure itself that your intention is genuine. This is because the duties in the Care Act begin from this point.

To assure itself that the intention is genuine, Lancashire County Council (as the second authority) will:

• establish and maintain contact with you (and your carer) about your intentions to move.
• continue to speak with the first authority to get their view on your intentions.
• ask if you have any information or contacts that can help to establish your intention.

Where it is clear that your intentions to move are genuine, Lancashire County Council must provide you (and your carer if they are also intending to move), with accessible information about the care and support available in its area. This should include but is not limited to, details about:

• the types of care and support available to people with similar needs, so you can know how they are likely to be affected by differences in the range of services available.
• support for carers.
• the local care market and organisations that could meet your needs.
• the Lancashire County Council charging policies, including any charges which you may be expected to meet for particular services (see Residential Care Charging Policy and Non-Residential Care Charging Policy).

6. If You Receive a Direct Payment

If you are moving from Lancashire, and currently receive a direct payment to meet some or all of your needs, you will need to consider how to meet any contractual arrangements put in place for the provision of your care and support. For instance, any contracts you may have with personal assistants who may not be moving with you.

7. Supporting You to be Fully Involved

7.1 Considering mental capacity

If you request assistance to understand the implications of a move on your care and support, Lancashire County Council should ensure that you have access to all relevant information and advice. This must include consideration of the need for an independent advocate in helping you to weigh up your options. This can apply whether you are moving to or from Lancashire.

There may be situations where you lack mental capacity to make a decision about a move, but your family wish to move you closer to where they live. In these situations, Lancashire County Council must first carry out supported decision making, supporting you to be as involved as possible and carry out a mental capacity assessment and where necessary then take ‘best interests’ decisions. The requirements of the Mental Capacity Act 2005 apply to all those who may lack mental capacity.

7.2 Preparing for the move

Once a move is definite, both authorities should identify a named staff member to lead on your case and be the ongoing contact during your move. These contacts should make themselves known to you and lead on the sharing of information and maintaining contact on progress towards arranging care and support for you and support for your carer. These contacts should be jointly responsible for facilitating continuity of care within an acceptable timeframe, taking into consideration the circumstances behind your intention to move, such as a job opportunity.

8. Sharing Information: How Local Authorities Must Work Together

If you are moving from Lancashire to another local authority area, it is essential that the following are provided to the second authority:

• a copy of your most recent care and support plan.
• a copy of the most recent carer’s support plan (if applicable).
• any other information relating to you or your carer (whether or not your carer has needs for support), that the second authority may request.
• any financial assessment or safeguarding plan that has been completed and, where a Deprivation of Liberty has been authorised, a new referral for a Deprivation of Liberty.

Throughout the assessment process, the first authority must keep in contact with the second authority about progress being made towards arranging necessary care and support for the day of your move.

You should be involved in any relevant meetings about the move. Meetings may not always be face-to- face where there are long distances between the local authorities involved. Having this three-way contact will keep you and your carers at the centre of the process and help ensure that arrangements are in place on the day of your move.

9. Assessment of Needs

If you have substantial difficulty and require help to be fully involved in the assessment or care planning process and there is no other suitable person who can support you, an independent advocate must be provided. The advocate should be provided by the second authority because it is taking over the responsibility for carrying out your assessment and care planning (see Independent Care Act Advocacy policy).

If you are moving to Lancashire, then a representative from Lancashire County Council will contact you and your carer to carry out an assessment of needs and to discuss how arrangements might be made. Lancashire County Council will also consider whether you are moving in order to be closer to a new carer and whether that new carer would also benefit from an assessment.

All assessments for adults with care and support needs, and for carers, must identify your needs and the outcomes you want to achieve. In carrying out the assessments, the second authority must take into account the previous care and support plan (or support plan) which was provided by the first authority.

10. Care and Support Planning if you are Moving to Lancashire

Following the assessment of needs and after determining whether you or your carer have needs which are eligible for support, you, your carer and any other person you request, must be involved in the development of your care and support plan (or your carer’s support plan) and take all reasonable steps to agree the plan.

Your care and support plan and carer’s support plan, including any personal budget, should be agreed in advance of the move to ensure that arrangements are in place when you move into the new area. This should be shared with you and your carer before the move so that you are clear how your needs will be met. Any differences between your original plan and your new care and support or support plan should be made clear. Such differences could arise where the range of services in one local authority differs from the range of services in another.

11. Personal Budgets

When setting your personal budget, the second authority should take into consideration any differences between the costs of making arrangements in the second authority compared with the first authority and provide an explanation for such any differences. Where there is a difference in the amount of the personal budget, this should be explained to you. It is important to try and ensure that any direct payment is in place in a timely manner since, for example, you may have a personal assistant that is also moving and who will require payment.

12. Arrangements for the Day of the Move

The care and support plan should include arrangements for the entire day of your move. This should be agreed by you, your carer(s) (existing and new as relevant) and both local authorities. The first authority remains responsible for meeting the care and support needs you have in your original home and when moving. The second authority is responsible for providing care and support when you and your carer move into the new area.

You are responsible for organising and paying for moving your belongings and furniture to your new home.

13. Integration with Healthcare

You and your carer(s) may have health needs as well as care and support needs. Both local authorities should work with their Integrated Care Board (ICB) to ensure that all of your and your carer’s health and care needs are being dealt with in a joined-up way.

Determining which NHS organisation has responsibility for commissioning your care and who has responsibility for paying is set out in Who Pays? Determining which NHS commissioner is responsible for commissioning healthcare services and making payments to providers.

If you also have health needs, Lancashire County Council should carry out the assessment if you are moving to Lancashire jointly with the ICB. Alternatively, if the ICB agrees, Lancashire County Council can carry out the assessment on its behalf. Where relevant, Lancashire County Council may use the cooperation procedures set out in the Care Act to require cooperation from the ICB, or other relevant partners.

Providing joint care and support and health plans will avoid duplication of processes and the need for multiple monitoring regimes. Information should be shared as quickly as possible with the minimum of bureaucracy. Local authorities should work alongside health and other professionals where plans are developed jointly to establish a ‘lead’ organisation which undertakes monitoring and assurance of the combined plan. Consideration should be given to whether you should receive a personal budget and a personal health budget to support integration of services.

14. Equipment and Adaptations

Many adults with care and support needs will also have equipment installed and adaptations made to their home. Where Lancashire County Council has provided equipment, it should move with you to the second authority where this is your preference, and it is still required and doing so is the most cost-effective solution. This should apply whatever the original cost of the item.

In deciding whether the equipment should move with you, the local authorities should discuss this with you and consider whether you will still need it, and whether it is suitable for your new home. Consideration will also have to be given to the contract for maintenance of the equipment and whether the equipment is due to be replaced – in which case it may be preferable to collaborate with the second authority about provision rather than the item being replaced by Lancashire County Council. The named staff members, in consultation with Occupational Therapy, from the local authorities will coordinate the move of any equipment or adaptations as part of your assessment.

As adaptations are fitted based on your accommodation, it may be more practicable for Lancashire County Council to organise the installation of any adaptations if you are moving to Lancashire. For example, walls need to be checked for the correct fixing of rails.

Where you have equipment on long-term loan from the NHS, Lancashire County Council must discuss with the relevant NHS body. The parties are jointly responsible for ensuring that you have adequate equipment when you move.

15. Documentation

If you are moving to Lancashire, Lancashire County Council must provide you, your carer(s) and anyone else requested with a copy of your assessments. This must include a written explanation where it has assessed the needs as being different to those in the care and support plan or the carer’s support plan provided by the first authority. Lancashire County Council must also provide a written explanation if you or your carer’s personal budgets are different to those provided by the first authority.

16. If the Second Authority has not Carried out an Assessment Before the Day of the Move

If a full assessment has not taken place prior to the move to Lancashire, then Lancashire County Council must put in place arrangements that meet your or your carer’s needs for care and support as identified by the first authority. These arrangements must be in place on the day of your move and continue until Lancashire County Council has carried out its own assessment and put in place a care and support plan which has been developed with you.

Lancashire County Council must involve you and your carer(s), and any relevant independent advocate, as well as any other individual that either you or your carer requests, when deciding how to meet the care and support needs in the interim period. The authority must take all reasonable steps to agree these temporary arrangements with you or your carer.

17. Matters which must be Considered when Making Arrangements

The Care and Support (Continuity of Care) Regulations 2014 require the second authority to have regard to the following matters when meeting the adult’s needs in advance of carrying out their own assessment:

17.1 Care and support plan

Your care and support plan, and your carer’s support plan (if the carer is also moving), which were provided by the first authority. Lancashire County Council should discuss with you and your carer how to meet your eligible needs and any other needs that the first authority was meeting that are not deemed as eligible but were included in either plan.

17.2 Outcomes

Whether the outcomes that you and your carer(s) were achieving in day-to-day life in their first authority are the outcomes you want to achieve in Lancashire, or whether your aims have changed because of the move.

17.3 Preferences and views

The preferences and views of you and your carer on how your needs are met during the interim period.

17.4 Equipment

Consideration should also be given to any contract(s) for the maintenance of any equipment used by you and whether the equipment is due to be replaced – in which case may be preferable to collaborate with the receiving area about provision rather than the first authority replacing the item. The named staff members, in consultation with Occupational Therapy, from the local authorities will coordinate the move of any equipment or adaptations as part of your assessment.

17.5 Changes in circumstances

Where you are moving to Lancashire, Lancashire County Council must consider any significant difference to your circumstances which could impact on your wellbeing, including:

Support from a carer: Whether you are currently receiving support from a carer and whether that carer is also moving with you. Where the carer is not moving, Lancashire County Council must consider how to meet any needs previously met by the carer, even if the first authority was not providing any service in relation to those needs.

Suitability of accommodation: Where the new accommodation is significantly different from the original accommodation, and this changes the response needed to meet the needs. For example, you may move from a ground floor flat to a first floor flat and now need assistance to manage stairs.

Access to services and facilities: Where the services and facilities in the new area are different, and in particular fewer than those in the originating area; (for example, access to food deliveries or other food outlets, access to public transport, or access to leisure or recreational facilities, or your workplace – a move from an urban to a rural environment could bring this about).

Access to other types of support: Where you were receiving support from friends, neighbours or the wider community and this may not readily be available in your new area. Or this could also happen where you previously made use of universal services such as drop in support, or befriending schemes, and these are not available in the new area.

Access to an advocate: If you have substantial difficulty in being fully involved in the assessment, care planning or review process the second authority should consider whether you need an independent advocate or if your original advocate could continue to support you.

Lancashire County Council should find out this information from relevant documentation sent to them or by talking to the individuals involved, and the first authority.

You or your carer(s) should not be on an interim care and support (or support) package for a prolonged period of time as a tailored care and support (or support) plan must be put in place. The second authority should carry out the assessment in a timely manner.

 18. If You do Not Move or the Move is Delayed

There are a range of reasons why a move may does not take place on the designated day. This may be, for example, because you are unwell, or there has been a delay in exchanging contracts as part of a house sale. Where there has been a delay because of unforeseen circumstances, both local authorities should maintain contact with you to ensure that arrangements are in place for the new date of the move.

If your move is delayed and you remain resident in the area of the first authority, you will normally continue to be ordinarily resident in that area and so the first authority will remain responsible for meeting your needs and those of any carer. Both local authorities may have incurred some expense in putting arrangements in place before the move was delayed. In such circumstances each of the authorities should consider agreeing to cut their losses incurred in preparing continuity of care.

Lancashire County Council reserves the right to consider request for recovery of costs and to respond appropriately and proportionately where costs are incurred as a result of making plans for you to move, but the move does not occur due to action or inaction on behalf of the first authority.

19. Disputes about Ordinary Residence and Continuity of Care

Where local authorities are in dispute over application of the continuity of care provisions, the authorities who are parties to the dispute must not allow their dispute to prevent, delay or adversely affect meeting your needs. Where the authorities cannot resolve their differences, the steps described in the Ordinary Residence guidance regarding disputes must be followed to ensure that you are unaffected by the dispute and will continue to receive care for the needs that were identified by the first local authority.

20. People Receiving Services under Children’s Legislation

Continuity of Care will not apply for those who are receiving services under children’s legislation. Where such a person has had a Transition Assessment, but is moving area before the actual transition to adult care and support takes place, the first local authority should ensure that the second is provided with a copy of the assessment and any resulting transition plan. Similarly, where a child’s carer is having their needs met by adult care and support in advance of the child turning 18 (following a Transition Assessment), the first local authority should ensure that the second is provided with a copy of the assessment and the carer’s support plan.  See also Adult Social Care Transition Policy.

21. Further Reading

21.1 Relevant chapters

Preventing, Reducing or Delaying Needs

Assessment of Needs

Eligibility

21.2 Relevant information

Chapter 20, Continuity of Care, Care and Support Statutory Guidance (Department of Health and Social Care)

Quality Statement 3: Continuity of Care and Support (NICE)