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Sunday 23 November 2008
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4. Practice Guidance
The following stages should be considered for all contacts.
The Devon Differentiated Approach to Care Management Policy describes the principles, processes and practice for each of these stages. Highlighted below are the issues specific issues for each of these processes that arise from the FACS approach.
Information to assist individuals to make arrangements to meet their own needs can be given at any stage, regardless of whether the person has needs above or below the threshold line for services.
Wherever possible people should be empowered to make arrangements to meet their own needs through the provision of wide ranging information and advice, including that about welfare benefits.
Practitioners should either give the information and advice requested or, with the person’s permission, contact another agency to ask them to provide the information and advice requested.
Information and advice is an appropriate response at the initial point of contact where:
Complete the Referral / Assessment / Review
This section should be read alongside guidance on the Single Assessment Process, Care Programme Approach and Person Centred Planning. A co-ordinated and integrated approach across relevant agencies will assist timely and consistent assessments.
Before embarking on a community care assessment, practitioners should first ascertain whether significant needs are described or suspected and whether a person appears to be in need of community care services; for example, are they disabled, a carer, or have an illness (ref. National Health Service and Community Care Act 1990 Section 47(1) (a)).
Access to carers assessments is defined by the Carers and Disabled Children Act 2000, where:
and
An assessment should only follow where these criteria are met. It therefore follows that not every contact will require an assessment, in particular requests for information about services (see above).
The case priority will be established at the referral and assessment stages using the new definitions for the categories A, B, C, D. This prioritisation is an indication of the case priority based on the presenting information ascertained at the initial point of contact. It does not indicate a person’s eligibility for services.
The level and type of assessment / review carried out should be determined by presenting needs and difficulties and will require practitioners to exercise judgement about how best to respond (ref. The Differentiated Approach to Care Management Policy).
The assessment / review will gather information about a person’s situation, needs and difficulties and identify the impact of those needs on the individual’s safety and / or independence. The review will also establish how far the support provided has achieved the outcomes set out in the care plan.
The assessment and review forms will help to gather the information in a structured format (ref. Differentiated Approach to Care Management Policy). The forms do not replace the need for practitioners to interpret and analyse the information collected in relation to each individual’s unique circumstances.
Alternatives to the need for social care assistance arranged by social services should always be explored and recorded at the assessment and review stages. This should include contributions from the individual, family, wider community, voluntary sector and other agencies, such as Supporting People and Care Direct.
Assessments / reviews will identify needs that other agencies are responsible for meeting. These agencies have their own policies for determining how services will be allocated. In these circumstances the Eligibility Criteria Checklist should not be completed as the Checklist is only used to determine if a person has eligible social care needs which require Social Services support. Social Services should not provide social care as an alternative to other agencies meeting their responsibilities.
Note : Completing an assessment / review is not a commitment by Social Services to provide or arrange social care services.
Evaluation and Analysis of Needs and Risks
Risk assessment is an integral part of the assessment and review processes and a critical part of determining an individual's eligibility for services.
Alongside identifying the individual's strengths and abilities, the individual and practitioner should clarify potential difficulties and possible risks that could lead to increased dependency, harm or danger including risks to carers or other close relationships if needs are not addressed.
Using the assessment / review information practitioners will need to predict how likely the risk is to occur.
In exploring the interaction between a person’s needs and risks the individual and practitioner should consider:
Risk assessments should explore what is an acceptable level of risk. The individual's attitude and wishes concerning risk taking and whether the risks are a normal part of independent living or one which cause serious concern. The individual and practitioners views should be recorded on the assessment form or specialist risk assessment.
For more details about risk assessment processes please refer to the Risk Assessment and Management of Individual Service Users Situations (RAMISUS) policy.
Completing the Eligibility Criteria Checklist
The Eligibility criteria checklist, Appendix 1 
(55KB - pdf help), must only be completed following an assessment or review, where the assessment has identified needs that may require social care support.
The Checklist provides a framework for practitioners to determine whether the need is set at a level that can be met by social services. It is a tool to assist decision making but does not replace the need for practitioners to make judgements about levels of needs and risks based on the assessment / review information.
Whilst an individual’s views should inform the decision making process, the practitioner is responsible for determining types of needs and the level of impact on, and risks to, a person's independence and safety if they are not addressed, using the assessment /review information.
The Eligibility Criteria Checklist is divided into:
The four need areas and four risk levels on the Eligibility Criteria Checklist are used to determine an individual's eligibility for social care services by:
The Carers section (Section 4) should be used to determine eligibility to services that carers have been assessed as needing as carers to support them in their caring role and to maintain their own health and well being.
Decision making in each section of the Eligibility Criteria Checklist must also take account of a person’s autonomy, that is, the freedom a person has over their immediate situation and the extent to which they are able to make and act on informed choices.
The 'threshold for services' line on the Checklist identifies the point when Devon will make arrangements for services.
Where no other appropriate alternatives are available social care support will be arranged by Social Services for eligible needs above the threshold for services line.
Needs below the threshold line will trigger information, advice or redirection to preventative or voluntary sector services.
A person is only eligible for social care support arranged by Social Services where:
and
In determining eligibility for services, staff must take account of the reasonable standards which a multi cultural society would expect, including any eligible needs arising from ethnic, religious or gender requirements, balanced against resource constraints thus enabling the council to discharge it's legal duty. In arranging services, cultural, ethnic, religious or gender requirements must be taken into account.
Note: It does not follow that once a person has some eligible needs for services, that all needs become eligible. Also, needs and risks may vary over time leading to a variety of outcomes at the review stage.
Interpreting the Statements on the Eligibility Criteria Checklist
The assessment / review will have identified the interaction between all of a person’s assessed needs and risks, the individuals views and attitudes towards the risks and the predictability and time frames within which they are likely to occur. This information will inform decision making on the Checklist about the level of seriousness of the risks in terms of harm or danger and the level of impact to an individuals independence.
For example, the impact of risks to an individuals independence, harm or danger will be influenced by factors such as the individuals housing circumstances and the level of support they receive from others such as carers, family, wider community, other agencies and voluntary organisations, and so on.
An individual's situation is unique and the interaction of needs and risks will vary according to each person’s situation, practitioners must use their skills to interpret and analyse the assessment / review information and to inform their judgements concerning eligibility. The assessment format will indicate whether a person is unable to do vital / most, many, some of the tasks or has difficulty with one or two activities.
However, Appendix 4 (60KB - pdf help) gives some guidance to assist practitioner decision making concerning critical, substantial, moderate and low. It is not a comprehensive list of all the possible situations that may fit the different levels of risks and must not be used to replace practitioner decision making in relation to each individual.
Care plans set out the agreed goals between the service user and practitioner and the support and intervention that can best meet the eligible needs.
Fair Access to Care Services requires that there is no service led Eligibility Criteria. Services are matched to eligible needs through the guidance contained in the Matching Needs and Services Guidance, which sets out the purpose of intervention and suggested service responses. Wherever applicable, the use of Direct Payments must be considered.
In deciding on levels and types of support practitioners should:
Reviews should follow the process for assessments and evaluation and analysis described above. No assumptions should be made about an individual’s needs.
An initial review should take within twelve weeks of the service being provided or major changes in service provision being effected. Reviews should then take place at least annually, more often if necessary.
One-off pieces of equipment do not need reviewing although major items should be reviewed at least annually to check for suitability and safety.
Service Delivery / Service Refusal
Where, for whatever reason, delays occur providing or arranging services, this should be discussed with the service user and carer. People will be prioritised according to the risks to their independence with critical needs first, then people with substantial needs and so on.
Where the service user and / or carer refuse help and services for whatever reason the following applies:
Monitoring and Review of the FACS Process
The purpose of Eligibility Criteria is to support the most effective and efficient use of available resources and to ensure consistency and fairness across the county and across service user groups.
It is therefore important that the application of the Eligibility Criteria is carefully monitored and reviewed on a regular basis.
The national policy requires councils to audit and monitor their performance in respect of fair access to care services in the following ways:
Appendix 3 (60KB - pdf help) specifies the quantitative measures and indicators that will support this monitoring process.
This will be achieved in Devon through its Performance Management and Quality Systems which include:
(60KB - pdf help) for details of relevant indicators and targets). The effective application of Eligibility Criteria is, to a large extent, determined by the skill and sensitivity of staff in assessing people's needs. Managers must ensure a culture of learning on the job through coaching and team learning opportunities with outcomes being evidenced on supervision files.
The national policy requires councils to put the following in place:
The line manager must ensure that new staff are familiar with the Eligibility Criteria to ensure employees act lawfully and within the policy of the Council.
In all cases service users and carers should be advised to first approach the assessing worker to discuss their concerns and then the local manager.
Following this where disagreements persist concerning the decision making about eligible needs the service user and / or carer has the right to access the complaints procedure which may include a second opinion.
It is important that all decisions are well documented and evidenced as set out in this policy.
Practitioners are accountable for:
Managers are accountable for:
In all circumstances variations to these criteria must be discussed with the line manager.
Some Important Points to Remember
[ Policy Contents | Appendix 1 (45KB - pdf help) ]
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