Actions Following a Care and Support Plan Review

1. Using this Procedure

This procedure should be used to carry out a range of actions following a Care and Support Plan Review.

Note: This procedure is used by all of the following teams and services:

• Croydon Adult Support;
• Hospital Discharge;
• Community Social Work (Assessment, Planning and Review);
• Disability Locality Teams and Transition.

2. Deciding the Timeframe for the Next Review

Statutory timescales for review

Under Section 27 of the Care Act 2014, the local authority must keep Care and Support Plans under periodic review. This means they must have a system or process in place to ensure that reviews are carried out and monitored in a manner appropriate to the needs and circumstances of the person whose plan it is.

Because every person is different, the Care Act does not specify the frequency in which a Care and Support Plan review must take place. That said, the statutory guidance does expect the local authority to endeavour to carry out a Care and Support Plan review as follows:

1. A review of a new service or Care and Support Plan should be carried out within 6-8 weeks of the service/change commencing;
2. A review of an on-going stable Care and Support Plan should take place no less than 12 months after the date of the 6-8 week review, and then no less than once every 12 months after that;
3. Where the person's needs or circumstances are likely to change reviews should be arranged as required to monitor the situation and respond to changes in a timely way (thus keeping the plan under review).

Note: If the person is in receipt of a Direct Payment, statutory timeframes for review of the Direct Payment do apply. Wherever possible, Care and Support Plan reviews should always be aligned with Direct Payment reviews to reduce duplication for both the person and the local authority.

For further guidance about Direct Payment reviews see: Reviewing a Direct Payment.

Deciding the timeframe for the next review

Decisions about the timeframe for review must consider:

1. The complexity of the needs being met by the plan;
2. The likelihood of deterioration or improvement in the person's needs or circumstances;
3. The complexity of the plan itself (for example the level of on-going involvement required to manage the plan);
4. The level of on-going risk to the person (from fluctuating needs or abuse and neglect);
5. The risk that the plan will breakdown; and
6. Whether any on-going monitoring activity is planned in between scheduled reviews.

Decisions about the timeframe for review must have regard for:

1. The views of the person about the timeframe for review;
2. The views of any carer about the timeframe for review;
3. The views of anyone else involved in the Care and Support Plan; and
4. The impact on Wellbeing of the timeframe proposed.

If you are unclear about an appropriate timeframe for review you should seek the advice of your line manager.

If the person (or their representative) is not happy with the timeframe for review that has been decided you must make them aware of their right to complain.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Click here to read the complaints policy and procedure.

Recording the timeframe for review

The agreed timeframe for the next review should be clearly recorded on the review record and the Care and Support Plan.

Where a short timeframe has been agreed you should record the rationale for this, especially if another person or team may be asked to carry out the next review.

Where you are making arrangements for a service to carry out the next review (rather than carrying it out yourself) you must make sure that you have recorded this in a way that will ensure the service carries out the review at the agreed time.

Information and advice about unplanned reviews

You must let the person with Care and Support needs know how they (or anyone else) can request an unplanned review outside of the agreed timescale if:

1. The Care and Support Plan is not working as intended;
2. Their needs change (increase or decrease);
3. Their circumstances change;
4. The plan is affected by any change in the circumstances of an informal carer (for example if a carer is able to provide more or less support than anticipated in the plan).

3. Providing Copies of the Plan

Providing a copy of the plan to the person

In all cases whenever there has been a change to the Care and Support Plan, or whenever an unchanged Care and Support Plan has been signed-off following a review you must provide a copy of the current Care and Support Plan to the person.

If you are of the view that the person will experience substantial difficulty understanding the plan then you must make sure that appropriate support is in place, including consideration of the duty to provide an independent advocate.

If an independent advocate is already in place they should be informed when the plan has been provided so they can support the person to understand it.

Providing a copy to others

Where the review was carried out jointly with another organisation to avoid duplication (for example housing or health) a copy of the plan must be made available to the other person that carried it out with you.

A copy should normally be shared in full with any carer unless the person has capacity and has asked you not to share the plan, or to share only part of the plan. In this case you will need to discuss and agree which elements of the plan are to be shared having regard for confidentiality.

In all other cases a copy of the Plan can only be shared with the person's consent (or in their best interests if they lack capacity to consent).

If the person consents (or lacks capacity and a best interest decision is made) a copy of the plan should be shared with the service provider who is responsible for providing Care and Support to the person.

A copy must also be shared with anyone that the person requests you share a copy with, even if they were not involved in the planning process itself.

Concerns about a request

Sometimes the person will request a copy of the plan is provided to a person who was not involved in the process. You must provide a copy of the plan to anyone that the person requests you to unless:

1. They lack capacity and you make a decision that sharing would not be in their best interests; or
2. You are concerned that doing so could put the person (or another vulnerable adult or child) at risk of abuse or neglect.

If this situation arises you should seek advice from your line manager and decide whether:

1. To share the record in full as requested;
2. To share the record partially, omitting sections where information could put the person at risk; or
3. To decline to provide a copy of the record (although the person can of course still choose to make a copy available from their own record).

Amending a Care and Support Plan

Sometimes the person (or their representative if they lack capacity) may ask for amendments to be made to the Care and Support Plan. You should:

1. Consider the request;
2. If the person whose Care and Support Plan it is has not made the request, consult with them (or their representative if they lack capacity); and
3. Review any evidence or information you have which may support or refute the request.

If you reach an agreement with the person about the need to amend the plan you should do so.

The amended plan will need to be signed off but this should be done in a proportionate way to reflect the level of the changes made to the plan. This may or may not involve a full sign off process.

The amended plan should be circulated to the same people as the original plan, unless the person requests otherwise.

4. When there are no Changes required to the Plan or the Personal Budget

If both the Care and Support Plan and the personal budget remain unchanged following a statutory review you should follow available local processes to sign off the plan for another review period.

5. Revising a Care and Support Plan

General Guidance

The Care and Support Plan can require revision following a review for a number of reasons. Some revisions will require a change to the personal budget but some will not.

Whenever you revise a Care and Support Plan you should refer to the various sections of the Care and Support planning procedure as required, facilitating an effective conversation. This can be accessed by clicking here.

The Care and Support planning procedure also contains appropriate links to:

1. The procedure for signing-off a plan;
2. Funding procedures; and
3. Financial assessment procedures.

Whenever you revise a Care and Support Plan you should also consider the need to revise any carer's Support Plan at the same time.

Examples of changes in circumstance that decrease a personal budget

1. An informal carer intends to provide increased levels of care (reducing the need for formal support);
2. The person no longer wishes to attend a day service, but will be going to a community group with a reduced cost instead;
3. There is going to be a change in service provision and the cost of this is less than the current provision;
4. Some needs are going to be met by an alternative provision, such as health or housing.

Examples of changes in circumstances that do not change the personal budget

1. The person will be changing the days that they receive formal support because of a change in college/work patterns;
2. The person has new outcomes that existing services will be supporting them to meet;
3. A new contingency plan within the same budget has been agreed.

Examples of changes in circumstance that increase the personal budget

1. The service provider has failed and the only appropriate alternative has an increased cost;
2. The needs of the person have not changed but an informal carer is no longer able to provide the same level of Care and Support;
3. The person was sharing costs of support with another person and that person no longer requires the support.

6. Ending a Care and Support Plan

When the person can request the Care and Support Plan is ended

The person (or their representative if they lack capacity) may only request that the Care and Support Plan is ended in the following situations:

1. When all eligible needs are to be met through informal care and/or alternative services outside of a personal budget (for example health provision); or
2. When the person has become self funding and intends to arrange and manage their own services without involvement of the Local Authority.

Any request to end the Care and Support Plan in these situations should be considered but should only be agreed if you are satisfied that:

1. Informal carers are willing and able to meet eligible needs; and/or
2. The informal and alternative services proposed are appropriate to meet eligible needs; and
3. The alternative services are available; and
4. If the person lacks capacity there is an appropriate person to arrange and manage services; and
5. The person is not at risk of abuse or neglect.

In addition, there may be a benefit in maintaining the Care and Support Plan with the person's consent (or in their best interests if they lack capacity) when:

1. Needs are complex or likely to deteriorate without on-going Local Authority involvement;
2. Circumstances are likely to change or deteriorate without on-going Local Authority involvement;
3. Risks to the person are likely to increase without on-going Local Authority involvement.

If you are at all concerned about ending the plan you should discuss the benefit in maintaining the plan with the person and any carer, although you are only able to continue the plan if:

1. The person has capacity and consents to continuing the plan; or
2. The person lacks capacity and a best interest decision is made to continue the plan; or
3. The person is at risk of abuse or neglect (in which case the plan must be continued).

If the plan continues you will need to consider any revisions that are required to it, in particular:

1. Changes to the services and support to meet eligible needs;
2. Changes to the personal budget and the way that it is managed; and
3. Changes to the contingency plan to manage risk.

Click here to access the procedure for revising a Care and Support Plan, including signing-off a revised plan.

Situations when the Local Authority can decide to end the plan

The Local Authority can only consider ending the plan when:

1. The person no longer has eligible needs; or
2. The person has capacity (or an appropriate representative to arrange and manage services on their behalf); and
3. The person is self funding (or becomes self funding at review); and
4. The person is having their eligible needs met in a care home (or will be moving into a care home); and
5. The Local Authority does not agree to arrange/continue to arrange and/or manage their services.

If the plan continues you will need to consider any revisions that are required to it, in particular:

1. Changes to the services and support to meet eligible needs;
2. Changes to the personal budget and the way it is managed; and
3. Changes to the contingency plan to manage risk.

Click here to access the procedure for revising a Care and Support Plan, including signing off a revised plan.

Arranging to end the services in the Care and Support Plan

If a decision is made to end the Care and Support Plan the duty for the Local Authority to meet eligible needs is not discharged until:

1. Alternative support/services are in place; and
2. Alternative support/services are meeting eligible needs.

You will need to consider any support that the person may need in order to arrange alternative services. This could involve:

1. Supporting the person directly to arrange an alternative service;
2. Monitoring when the person has arranged the service themselves;
3. Liaising with another person to do so (for example a carer or an advocate).

When alternative support/services are arranged you can end the support that was being provided by the Local Authority. This could be a staged approach to terminating services, in line with the time that different alternative services begin, or an all-encompassing approach with a clear end date for all services.

Ending the financial contribution

Whenever services are no longer provided through a personal budget you must notify the financial assessment service so that arrangements can be made to:

1. Cancel any financial contributions after the date that services ended; and
2. Reimburse any monies that may be owing to the person.

Ending the Care and Support Plan

You can end the Care and Support Plan itself when you are satisfied that:

1. Alternative services are in place;
2. Eligible needs are being met; and
3. The services provided by the Local Authority have been ended.

Upon ending the Care and Support Plan you must:

1. Provide the person with any information and advice they request (or you feel would be beneficial) about available appropriate services to meet their needs;
2. Provide them with information and advice about ways they can prevent, reduce or delay needs;
3. Provide them with any other information that they request or that you feel will be beneficial;
4. Consider the support the person may need to contingency plan;
5. Explain to them what they should do if the informal or alternative support breaks down in the future;
6. Agree any monitoring arrangements you deem necessary;
7. Explain to them what to do if they change their mind about arranging their own services (where a person has requested the Care and Support Plan is ended);
8. Explain to them what they should do if their needs or situation changes (for example if the financial resources of a person self-funding a care home placement reduce); and
9. Carry out any Care and Support processes with the carer as agreed.

All of the above information should be confirmed in writing.

Closing the case

You should consider closing the case when:

1. The Care and Support Plan is ended (because all alternative support is in place and meeting needs);
2. There is no need to monitor the situation; and
3. The person (or their representative if they lack capacity) knows what to do should their circumstances change or they no longer wish to arrange their own services.

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship;
2. Deputyship;
3. Carers support;
4. Tenancy in extra sheltered housing.

Click here to access the process for ending your involvement and closing a case.

7. Changing the Method of Managing the Personal Budget

When a change should be considered

A change in the method of managing the personal budget should be considered whenever:

1. The person requests it (or their representative if they lack capacity);
2. The Local Authority identifies a different method of managing the budget as more appropriate (to meet needs, outcomes or promote Wellbeing); or
3. There are issues with the current method of managing the budget (for example misuse of a Direct Payment).

The different ways to manage the personal budget

Click here to access the procedure for deciding how to manage a personal budget, including which methods are available and what must be considered.

Promoting Direct Payments

The Care Act expects you to promote the use of Direct Payments. This means that whenever you identify that a Direct Payment may be an appropriate way to manage all (or part) of a personal budget you should discuss the benefits of doing so and support access to a Direct Payment.

'Direct Payments-A Route to Independence' is a local information resource that can be emailed or given to anyone who is interested in having a Direct Payment. It can be found in the Local Resource area by clicking here.

Click here to access the Direct Payment procedures, including when a Direct Payment can and cannot be arranged and the process for doing so.

Ending a Direct Payment

You must end a Direct Payment agreement if:

1. The person becomes subject to a requirement, license or order to undergo drug or alcohol rehabilitation, behaviour therapy or testing; or
2. The person will be moving (or has moved) into a care home.

You should consider ending a Direct Payment if any of the following situations apply and no resolution to continue the Direct Payment can be found:

1. The person managing the Direct Payment has breached a condition of the Direct Payment Agreement;
2. The person managing the Direct Payment has not been using the Direct Payment to meet eligible needs;
3. The person has become incapacitated and there is no suitable person to manage the Direct Payment;
4. The Direct Payment is being used to pay for a family member living in the same household as the person to provide care without prior agreement;
5. A Direct Payment is no longer deemed the most effective way to meet the person's needs.

Click here to access the Direct Payment procedure, including how to end a Direct Payment Agreement.

Arranging a Direct Payment

Click here to access the Direct Payment procedure, including when a Direct Payment should be arranged and how to arrange a Direct Payment.

Recording changes and Sign-off

You must clearly record on the Care and Support Plan how the personal budget is now being managed.

When revisions have been made to the Care and Support Plan it will need to be signed-off. The procedures for signing-off a Care and Support Plan can be accessed by clicking here.

Changes to other areas of the plan

If the changes to the method of managing the personal budget also mean the support and services provided in the plan will change you must revise the plan to show any:

1. Changes to the services and support to meet eligible needs;
2. Changes to the personal budget; and
3. Changes to the contingency plan to manage risk.

8. Changing the Provider of Formal Services

Ending the current service and arranging a new one

During the review it may be agreed that a change in service provision is the most appropriate way to resolve issues with the Care and Support Plan. This decision must be made with regard for:

1. The person's views about any change in provider;
2. The views of any carer; and
3. The impact of the change on the person's Wellbeing.

When a decision has been made to change the provider of formal services you should use the Commissioning and Brokerage Procedures to:

1. End the current service; and
2. Arrange a new service.

Concerns about a provider

If the current service is being ended because you have concerns about the provider you have a responsibility to:

1. Take any appropriate action under safeguarding; and
2. Raise general concerns.

Click here to access the procedure for raising a safeguarding concern.

Click here to access the procedure for raising general concerns about a provider.

Revising the Care and Support Plan

You must revise the Care and Support Plan so that the new support and services being provided to the person to meet their eligible needs are clearly recorded.

You must also revise other areas of the plan affected by the change in support/services, including any:

1. Changes to the method of managing the personal budget;
2. Changes to the personal budget; and
3. Changes to the contingency plan to manage risk.

9. Reassessment of Need

Whenever a review has identified that the person's need for Care and Support has changed a proportionate reassessment of need should take place. This applies regardless of whether the change indicates an increase in needs for support or a decrease. No revision of a Care and Support Plan can be made until current needs have been established and eligibility determined.

The process of reassessment is the same as the process of assessment, but it must take into account all of the information gathered at review to:

1. Avoid unnecessary duplication; and
2. Establish changes in need as quickly as possible.

10. Arranging Urgent and Interim Support

If the review has identified that there has been a change in need or circumstance you will need to consider the need to provide urgent or interim support to ensure that the duty to meet needs is fulfilled during the time that:

1. The reassessment of need is taking place; or
2. The Care and Support Plan is being revised; or
3. Steps are being taken to resolve issues with informal or alternative support provision.

Click here to access the procedure for providing urgent and interim support, including when support should be considered, deciding how to meet urgent needs and arranging funding for urgent support.

11. Monitoring

Arranging to monitor a Care and Support Plan

The Care Act requires you to make proportionate and appropriate arrangements to monitor the Care and Support Plan whenever this is required.

Examples of situations when monitoring may be required include:

1. If the plan is deemed unstable even with contingency;
2. If the person's needs are expected to change in the short term (impacting on the level of support they will need);
3. If there is a likely risk of deterioration in needs or circumstance without monitoring;
4. As part of ongoing MDT involvement;
5. If you are coordinating the follow up of an action plan agreed at review;
6. To manage the risk from abuse or neglect.

The arrangements to monitor must be:

1. Proportionate and appropriate to the person's situation and risk;
2. Agreed with the person (or their representative if they lack capacity) and any carer; and
3. Agreed from a strengths based approach to promote resilience of the person and their informal networks of support.

If you are unclear about the need to monitor you should seek advice from your line manager.

Recording monitoring arrangements

Monitoring arrangements must be clearly recorded.

Where you are making arrangements for a service to monitor the situation (rather than monitoring it yourself) you must make sure that you have recorded this in a way that will ensure the right service carries out monitoring activity at the agreed time.

Monitoring

Monitoring should take place as agreed unless:

1. There is a need to revise the monitoring arrangements (due to an unexpected change in need or situation);
2. There is a need to carry out a different Care and Support function (for example a reassessment); or
3. Monitoring is no longer proportionate or necessary.

Any monitoring activity carried out should be clearly recorded and you should use supervision effectively to discuss and agree the need for continued monitoring.

When reducing or ending monitoring activity you should do this with regard for:

1. The person's views about the need to monitor;
2. The carer's views about the need to monitor; and
3. The impact on the person's Wellbeing of any decision (including their personal resilience).

Future reviews

Where monitoring of a Care and Support Plan is on-going consideration should be given to any subsequent statutory reviews being 'light touch; in nature.

Ending monitoring activity

If monitoring is no longer appropriate or required you should:

1. Ensure that a statutory review date is agreed and clearly recorded;
2. Explain to the person (or their representative) what steps to take should their needs or situation change;
3. Provide any information and advice as required; and
4. Cease monitoring activity.

If you are unclear about the need to monitor you should seek advice from your line manager.

If the person (or their representative) is not happy with any decision to reduce or end monitoring arrangements you must make them aware of their right to complain.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Click here to read the complaints policy and procedure.

12. The Provision of Information and Advice

The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for Care and Support applies at all times.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

Click here to read about the duty to prevent, reduce or delay needs.

Click here to read about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

Following the review process it is important that you:

1. Offer information and advice as appropriate, including signposting to other sources;
2. Discuss options to prevent, reduce or delay the need for Care and Support; and
3. Give the person and anyone else involved opportunities to ask questions or seek clarity.

Click here to access the general information and advice procedures, including access to local and national information and advice resources (general and specialist).

13. Accessing a Prevention Service

Under section 2 of the Care Act the Local Authority must take opportunities to provide directly (or provide access to) prevention services whenever these may be of benefit in preventing, reducing or delaying needs for Care and Support.

In Croydon, the local approach is to work with partners on prevention in a way which is:

1. Personalised-responsive and flexible depending on the person;
2. Based on what people want to achieve in their lives;
3. Asset focused-building on what people and their communities can do and promoting new ideas;
4. A positive experience-engaging with people and learning as part of continuous improvement;
5. Integrated-whole system approach where services work in a joined up and seamless way; and
6. Efficient-better use of resources and understanding how they work.

If, following a review you feel that a prevention service may be an appropriate service for the person you can use the links below to find out about how to access different services.

Click here to find out about accessing the Reablement service (part of the LIFE Team).

Click here to access the Telecare and Careline Plus procedures.

Click here to find out about accessing the Adult Community Occupational Therapy Service (ACOT).

Click here to find out about accessing the health and wellbeing service Just Live Well.

14. Requesting a Financial Reassessment

When a financial assessment may be required

Following the review process you should consider any need to request a reassessment of the person's financial resources.

It is not lawful for the Local Authority to charge a person more than they can afford. Equally people should contribute what they are able to, so you have a duty to notify the service with responsibility for financial assessment if you become aware that:

1. A person's financial situation has changed (either improved or deteriorated);
2. A person is having difficulty making their contribution;
3. The personal budget is going to be changed;
4. The person is going to be using informal or non-chargeable services to meet some or all of their needs.

You should explain to the person (or their representative if they lack capacity)that you are going to be requesting a further financial assessment and why. You should provide them with information and advice as required about the financial assessment process. This is particularly important if the person has not had a financial assessment before.

Click here to access information about providing information and advice about financial assessment.

Recording the outcome of the financial assessment

Following a financial assessment the contribution that the person has been assessed to make must be clearly recorded:

1. On the person's Care and Support Plan;
2. On internal financial contribution recording systems.

The start date for any financial contributions should correspond with the start date for the associated Care and Support services (when these have changed) or the date that the financial assessment was carried out (when services have not changed) unless a decision has been made otherwise through the financial assessment process.

15. Safeguarding Concern

If, as part of any conversation you have with a person or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately by raising a concern.

Adults

Click here to access the safeguarding adults procedures. They explain how to recognise abuse or neglect and how to raise a concern.

Children

Urgent concerns relating to a child should be raised by calling 0208 255 2888. Outside office hours call 0208 726 6400 and ask to speak with the out of hours team.

Non-urgent referrals should be made using the Single Point of Contact Referral Form.

Note: When raising an urgent concern by telephone you must also complete the Single Point of Contact Referral Form.

Click here to access the online version of the Referral Form.

A downloadable version of the form is also available at the Croydon Council website.

If you wish to consult with a social worker before making a referral you can call 0208 726 6464 during office hours. However you should only do so if the case is not already allocated to a social worker and the child lives in the Croydon area.

For more information about Safeguarding Children visit the Croydon Safeguarding Children Board website by clicking here.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialling 999.

16. Reporting Concerns about a Service Provider

Why it is important to report concerns

Under section 5 of the Care Act the Local Authority has a duty to maintain an effective and efficient market of services for meeting Care and Support needs in the local area. A key part of maintaining a market place is understanding what is working and not working about the marketplace. It is therefore important that you report any concerns you have about any organisation providing any kind of Care or Support.

The local marketplace includes:

1. Services that are commissioned by the Local Authority;
2. Services that are provided by the Local Authority (for example, Reablement);
3. Services used by self funders and people who have a Direct Payment;
4. Universal services available to all residents; and
5. Services provided by partner agencies (for example health or voluntary services).

Managing risk to the person

In all cases, you must take appropriate steps to manage the risk to an individual posed by the poor practices of a service provider. Effective ways of managing the risk could be:

1. Raising a Safeguarding concern;
2. Arranging an alternative provider (there is a duty to do this when a regulated provider fails);
3. Agreeing monitoring arrangements.

Reporting concerns about regulated Care and Support services

The commissioning service are responsible for ensuring that regulated Care and Support services are safe and of a high standard when:

1. They are commissioned by the Local Authority (services provided in the Local Authority area or outside of it); or
2. They are being used by people who have a Direct Payment (services in the Local Authority area); or
3. They are available to people who self fund or use a Direct Payment (services in the Local Authority area only).

You should notify the commissioning service if you have general concerns about any of the following:

1. Domiciliary Care Providers commissioned by the Local Authority (either in the local area or outside of it);
2. Domiciliary Care Providers available in the local area but not commissioned (used by people with a Direct Payment or self-funders);
3. Residential and nursing homes commissioned by the Local Authority (either in the local area or outside of it)
4. Residential and nursing homes available in the local area but not commissioned (used by self-funders);
5. Reablement services provided or commissioned by the Local Authority;
6. Regulated day services (those providing personal care) commissioned by the Local Authority or available in the local area;
7. Any other regulated Care and Support provision (for example Care and Support provided as part of a residential college placement).

Where you are providing details about a particular incident involving a person with Care and Support needs you should:

1. Make the person aware that you are raising the concern and why; and
2. Establish whether they consent to be contacted as part of any further information gathering if required.

The commissioning service will determine the most appropriate response to the concern that has been raised, which could include:

1. Contract renegotiation with a commissioned provider;
2. Agreeing and monitoring an action plan with the provider;
3. A temporary stop on the use of a provider;
4. A large scale safeguarding response;
5. Joint work with another Local Authority (when the provider is not local);
6. A recommendation to information and advice services not to signpost to a provider;
7. Notification of concerns to the Care Quality Commission;
8. A letter to people who use a service.

You may be asked to support the commissioning service by providing additional information or assisting in any investigation process they undertake. You are required to co-operate with any request under the Care Act unless doing so will:

1. Prevent you from effectively carrying out other duties under the Care Act; or
2. Prevent you from effectively carrying out duties under any other legislation.

Reporting concerns about unregulated Care and Support services

Unregulated Care and Support services are generally services that do not provide personal care, and so do not have to be registered with the Care Quality Commission. They include:

1. Some day services;
2. Prevention services provided by housing;
3. Health services;
4. Colleges and training centres;
5. Advocacy services;
6. Voluntary and charitable services.

If the services are commissioned by the Local Authority you should report concerns to the commissioning service in the same way that you would report a concern about a regulated Care and Support service.

If the services are provided by a partner organisation (such as health, housing or education) there will be local arrangements in place to report concerns. If you do not know what these arrangements are you should:

1. Speak to your line manager; or
2. Speak to the commissioning service.

Where you are providing details about a particular incident involving a person with Care and Support needs you should:

1. Make the person aware that you are raising the concern and why; and
2. Establish whether they consent to be contacted as part of any further information gathering if required.

Concerns about a personal assistant 

When concerns arise about the practice of a personal assistant you should discuss your concerns with:

1. The person with Care and Support needs (or their representative if they lack capacity);
2. Any carer; and
3. The person receiving the Direct Payment (if this is not the person or the carer).

Depending on the nature of the concern it could be resolved through:

1. A conversation with the personal assistant to discuss the concerns and identify action required to resolve them;
2. The provision of training to the personal assistant (for example manual handling training);
3. A review of the working conditions and requirements in the contract to make sure that the tasks to be completed are clear.

If specialist information or advice is required or requested (for example relating to employment law) you should contact the Direct Payment Support Service.

If presenting issues cannot be resolved or you remain concerned about the continued suitability of the personal assistant you should consider:

1. Any monitoring arrangements required;
2. The need to add a condition to the Direct Payment, that the Direct Payment cannot be used to employ the personal assistant; or
3. The need to end the Direct Payment.

Any decision must have regard for:

1. The views of the person with Care and Support needs;
2. The views of any carer;
3. The views of the person receiving the Direct Payment (if this is not the person with Care and Support needs); and
4. The impact on the person's Wellbeing.

You should seek the advice of your line manager and the Direct Payments Support Service as required.

Concerns about a personal assistant providing support to others

If you know that the personal assistant is providing Care and Support to other individuals in the local area you must consider any further action required. This could be:

1. Notifying the Direct Payment service of the concerns so they can take appropriate action to notify others;
2. Raising a safeguarding concern in respect of another individual being supported by the personal assistant.

17. Whistleblowing

When to raise concerns

The Local Authority values openness, transparency and candour and encourages you to raise concerns as soon as possible about the practice of any individuals (whether they are employed by the Local Authority or not) that you feel:

1. Compromises the safety or Wellbeing of a person with Care and Support needs; and/or
2. Compromises the safety or Wellbeing of a carer with support needs; and/or
3. Compromises the safety of a child.

Examples of individuals employed by the Local Authority include:

1. A social worker;
2. An occupational therapist;
3. Unqualified workers in social work or occupational therapy services;
4. A Reablement support worker;
5. Support workers in Local Authority day services;
6. Individuals employed in other areas of the organisation (such as housing officers and teachers in Local Authority schools or colleges).

Examples of individuals employed by other organisations include:

1. Health professionals (for example a community or district nurse, a GP, a Psychiatrist or Psychologist, a Speech and Language Therapist. An Optician or a Dentist);
2. Police Officers;
3. A support worker in a charitable organisation;
4. An advocate.

The legal context for Whistleblowing

Whistleblowing is part of the Public Interest Disclosure Act 1998 (PIDA). Under the Act you:

1. Must be provided with a safe space in which to raise the concerns;
2. Must be taken seriously;
3. Cannot be subjected to any detrimental or unfavourable treatment and victimisation by the Local Authority or individuals as a result of making a disclosure.

Providing evidence of concerns

Legally you do not have to provide any hard evidence to support a whistleblowing disclosure, but if you have any evidence you should always provide it. This could be:

1. Details of when a specific incident occurred;
2. A witness statement written by you or that has been provided to you;
3. Other documentary evidence (for example an email or letter).

Further advice

If you require further advice about whistleblowing before making a disclosure you can contact the Whistleblowing Helpline:

1. By telephone on 08000 724 725;
2. By email at enquiries@wbhelpline.org.uk.

Raising a concern