Devon County Council

Index of questions

• How do we decide the level of services that an individual needs once they have an eligible need?
• Is there something in FACS restricting eligibility for where only one service / item is required?
• When is equipment a health need and when is it a social care need?
• What should I do if a person has an eligible need but refuses the services?
• How do we know whether to provide services to the person cared for or their carer?
• Can you advise whether FACS has a bearing on how much respite we can offer now?
• What guidance can you give on withdrawing or reducing services?

How do we decide the level of services that an individual needs once they have an eligible need?

• The following principles should assist with deciding on levels and types of services to meet eligible needs including equipment and adaptations:

• Eligible Needs must be met in the most cost effective, simple and efficient way.
• The service response should be the minimum required to meet the eligible need in the most cost effective manner and appropriately address the outcomes required.

• The draft Matching Needs and Services guidance should assist decision making in specific situations.
• However, the document provides guidance only and does not replace the complex discussions and decision making that practitioners and managers undertake at the care planning / panel stages.

In this way care planning should be person centred, based on the risks to independence / safety / sustainability of role for individuals.

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Is there something in FACS restricting eligibility for where only one service / item is required?

• FACS does not determine eligibility according to the number of services / items required to meet needs.
• Assessment is the key process as eligibility is determined by the level of risk to independence or safety of the individual if needs are not addressed.
• The Matching Needs and Services guidance should also assist decision making re the type and level of support required to meet eligible needs.

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When is equipment a health need and when is it a social care need?

• Where appropriate, the preference is to enable disabled people to carry out daily activities by providing rehabilitation / training in alternative techniques rather than provide equipment.
• However, health is empowered to provide aftercare services for patients and this can include equipment and minor adaptations.
• Social Services can provide the same to those with a substantial and permanent disability under the Chronically Sick and Disabled Person Act 1970 or to "old people" under the Health Services and Public Health Act 1968 but this latter act gives a power not a duty to provide. (see legal framework guidance )
• For both acts we should only consider providing equipment when we are satisfied it is necessary and appropriate.

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What should I do if a person has an eligible need but refuses the services?

• The outcome depends on what the reason for refusal is. For example, is there a vulnerable adult issue? If so, follow the Vulnerable Adult policy and processes.
• Is the person able to make informed judgements? Are there any mental health issues? Does the individual have a representative?
• However, if there are no major concerns then the standard letter for service refusals should be sent to the individual together with any assessment documentation the individual wishes to receive.

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How do we know whether to provide services to the person cared for or their carer?

• The national policy guidance in the Carers and Disabled Children Act advises:
• Following assessment the best outcomes for both cared for people and carers are still likely to result from the provision of good quality community care services for the person cared for.

• It goes on to state:
• The local council must consider the information gathered and decide whether to provide services to the carer. …….It follows that some services could be delivered as carers services under the Act that could also be delivered as community care services. … the local councils decision is to be made….. on the basis of the best way of meeting the assessed needs within the caring relationship.

• For example, the assessment identifies the carer needs a break from the caring role. This is then recorded on either the joint or separate carer assessment documentation. The person cared for is then assessed for the additional support that they will need to allow their usual carer to take a break. This need will be recorded on their assessment form.

• Where there is an eligible need, the additional service remains a community care service delivered to the person cared for, not a service under the Carers and Disabled Children Act 2000.
• There are exceptions, for example when the person cared for refuses to accept services or to have an assessment. They may however be willing to accept help from social services that helps the person who cares for them. An example is the delivery of non-intimate sitting service provided as a carers service to give the usual carer a short break - reference the Carers and Disabled Children Act 2000 practice guidance.
• Note: Where carers have eligible needs, Section 2 of the Carers and Disabled Children Act 2000 gives local authorities a 'power' to provide services following a carers assessment, not a duty.
• See legal framework for community care and for information about carers services.