4.1.5 Review of Care and Support Plans

Audio & Quick Read Summary

1. Introduction

This policy sets out Lancashire County Council’s response to the Care Act duty to ensure that a review of care and support plan occurs and, if required, a revision of the plan or re-assessment following this review process.

2. Policy Aim

The policy aims to support adults in their own home and local community:

• To have the opportunity to reflect on what is working, what is not working and what might need to change with their care and support/support plan.
• To ensure that any changes in their care and support needs are identified and can continue to be met.
• To request a review of their care and support plan should they or their carer wish to do so.

3. The Legal Framework

Reviews are an important part of the planning process as without a system of regular reviews, plans could quickly become out of date, meaning that you do not receive the care and support required to meet your needs. Plans may also identify outcomes that you want to achieve which are progressive or time limited, so a periodic review is vital to ensure that the plan remains relevant to your goals and aspirations.

This review process, just like the original Care and Support Planning process, should be person-centred and outcome-focused at all times, as well as accessible and proportionate to the needs to be met. The process must involve you (and your carer where possible) and consideration must be given whether to involve an independent advocate as specified in the Care Act.

Care and support plans should not be revised without a thorough review to ascertain if a revision is necessary, and in your best interests – although there may be some circumstances where a so-called “Light Touch” is appropriate.

Consideration should also be given to authorising others to conduct a review, this could include your or your carer, a third party (such as a provider) or another professional, with Lancashire County Council adopting an assurance and sign-off approach.

The review will help to identify if your needs have changed and, can in such circumstances, lead to a reassessment. The review must not be used as a mechanism to arbitrarily reduce the level of your personal budget. The review should also consider safeguarding principles and ensure that you are not at risk of abuse or neglect.

In addition to the duty to keep plans under review generally, the Care Act places a duty on Lancashire County Council to also conduct a review if a request for one is made by you or a person acting on your behalf. Lancashire County Council will provide information and advice at the planning stage about how to make a request for a review. This process will be accessible and include multiple routes to make a request, such as telephone or email.

An initial review will be completed 6-8 weeks after agreement and sign-off of a plan and personal budget so as to ensure that the arrangements are accurate and there are no initial issues. It is the expectation that the next and subsequent reviews of the plan will be conducted no later than every 12 months. All reviews should be proportionate to the needs to be met, and the process should not contain any surprises for you as the adult receiving care and support.

This policy applies to adults in need of care and support and carers, unless specifically stated.

4. Types of Review

In many cases, the review and revision of the plan will be intrinsically linked; it should not be possible to decide whether to revise a plan without a thorough review to ascertain if a revision is necessary, and in your best interests. In addition, where a review is being carried out, and you also have a carer, Lancashire County Council should consider whether the carer’s support plan requires reviewing at the same time too.

4.1 Planned review

This is set at the time of the original care and planning process.

During the planning process, you and your social care worker, or relevant professional may discuss when to review the plan. This can be useful as it means you can anticipate when the review will take place, rather than the review being an unexpected experience. It also personalises care and support, as you may have a view as to a suitable time for the review to occur.

The first planned review will be an initial ‘light touch’ review of the planning arrangements 6-8 weeks after sign-off of the personal budget and plan. Where relevant, this will also be combined with an initial review of direct payment arrangements. This will provide reassurance to all parties that the plan is working as intended and will help to identify any teething problems.

There are a range of review options available, which include self-review, reviews conducted remotely, or face-to-face reviews with a social care worker or other appropriate person or professional: these will be proportionate to the circumstances, the value of the personal budget and any risks identified. In all instances, the method of review should be agreed with you (and your carer if appropriate) and all reasonable measures taken to ensure your involvement and the involvement of other people you identify, including an independent advocate where this is required under the Care Act.

If you are recorded as having a mental impairment and lacking mental capacity to make some decisions, then the social care worker, other appropriate person or professional will consider carefully when the next review should take place. Where conditions are progressive, and your health is deteriorating, reviews may need to be much more frequent. Similarly, if you have few or no family members or friends who can support you, the risks are higher, and so reviews or monitoring may need to take place more often.

4.2 Unplanned review

This results from a change in needs or circumstance that Lancashire County Council becomes aware of, e.g. a fall or hospital admission and or emergency.

If there is any information or evidence that suggests that circumstances have changed in a way that may affect the efficacy, appropriateness or content of the plan, then the social care worker will immediately conduct a review to ascertain whether the plan requires revision, e.g. where a carer is no longer able to provide the same level of care, there is evidence of a deterioration in your physical or mental wellbeing or Lancashire County Council receives a safeguarding alert. During the review process, you, or the person acting on your behalf, should be kept fully involved and informed of what is occurring, the timescales involved and any likely consequences. This will help to alleviate anxiety at a time where things in your life may have changed substantially.

4.3 Requested review

This is when you or your carer, family member, advocate or other interested party makes a request that a review is conducted.  This may also be as the result of a change in needs or circumstances.

The right to request a review applies not just to your, but to others supporting you or interested in your wellbeing. The social care worker should consider the request even if it is not made by you or your carer. The request process should be accessible and streamlined, available online, by phone or in writing.

When a request to conduct a review is received (the opportunity for which should be made clear during the original planning process), Lancashire County Council should consider this and judge the merits of conducting a review. In most cases, it is the expectation that a review should be performed.

However, if the assigned worker is reasonably satisfied that the plan remains sufficient, or the request is frivolous, inaccurate or is a complaint, a review does not have to be undertaken.

Where a decision is made not to conduct a review following a request, Lancashire County Council will set out the reasons for not accepting the request, in a format which is accessible to you along with details of how to complain. If you are not satisfied with this decision, Lancashire County Council will explain when you can expect a scheduled review of your plan.

There will be occasions when a change to a plan is required but there has been no change in the level of need (e.g., a change of provider). There may also be small changes in need, at times temporary, which can be accommodated within the established personal budget (e.g., when a carer changes the times when they are available to support). In these circumstances, it is not appropriate for you to go through a full review and revision of the plan. Lancashire County Council will deal with these ‘light-touch’ requests in a proportionate and reasonable way.

Where a full revision of needs, outcomes and support is necessary, the social care worker must work through the assessment and care planning processes as detailed in Assessment of Needs and Care and Support Planning. The assessment process following a review should not start from the beginning of the process, but pick up from what is already known about you and will be proportionate.

Particular attention will be taken if the revisions to the plan propose increased restraints or restrictions on you where you do not have the mental capacity to agree them. This may become a Deprivation of Liberty (DoLS), which requires appropriate safeguards to be in place.

5. Further Reading

5. 1 Relevant chapters

Providing Culturally Appropriate Care

Care and Support Planning

Preventing, Reducing and Delaying Needs

5.2 Relevant information

Chapter 13, Review of Care and Support Plans, Care and Support Statutory Guidance (Department of Health and Social Care)

See also Review of Care and Support Plans Case Studies, Resources