Deciding the Outcome of a Contact or Written Referral

1. Possible Outcomes

Taken from the Care Act statutory guidance, the following are just some of the possible outcomes of any type of contact or referral.

Recording of information only;
The provision of Information and Advice;
The provision of a preventative service (or supporting access to a prevention service provided by a partner organisation such as health);
Professional support without assessment;
Taking a telephone referral for assessment (duty);
Allocation for a needs assessment;
Transfer of the referral to another service in the Local Authority for an assessment;
Joint assessment with another service in the Local Authority;
Joint assessment with another Local Authority or organisation (for example, health);
The review or revision of an existing Care and Support Plan; or
A combination of the above.

The outcome should not be prescribed or predetermined by factors such as the financial resources the person or the Local Authority has available. It should be fair and should represent the most appropriate and proportionate way to meet the needs of the person at that time. Additionally, there should not be variance between outcome decisions made about people who have similar needs in similar circumstances

Click here to access a tri.x tool that can be used to support decision making following a contact or referral.

Case Examples

Example 1:

Greg has contacted the Local Authority because his mum is getting older and is finding some household chores more difficult than she used to. He doesn't know what help is available and is also worried about the future. The Local Authority provides Greg with contact details for various agencies that offer help with domestic chores and talk through the adult Care and Support assessment process with him. They also provide the details of a financial advice organisation so that Greg can find out what the financial implications of any future Care and Support needs may be for his mum.

Example 2:

Susan has been unwell lately and is lacking in confidence to do her weekly shopping. She has a computer and has been purchasing heavier items online but misses the social aspect of shopping and would like to be able to do a smaller shop in person. She has called the Local Authority for help. The Local Authority establishes that, while Susan has a large network of friends they all work and are not able to commit to supporting her with this. It is agreed that a referral will be made to the reablement service for a few weeks to support Susan to gain confidence to achieve her goal of carrying out a small shop each week.

Example 3:

Matilda has been recently diagnosed with a long term progressive illness. This has thus far affected her mobility but is likely to impact on other areas of her life over the coming months and years. Matilda has a good network of family support that is willing and able to continue supporting her with meeting most needs, although they are finding manual handling problematic. The Local Authority agrees for a social worker and an occupational therapist to complete a joint assessment of Matilda's needs. This approach will ensure that current manual handling needs are met, that strategies for preventing or delaying the development of other needs are agreed, that carers needs are understood and supported and that options for the future are discussed and explored at an early stage.

2. What must be Considered

Legal Requirements in all cases

The Care Act places certain duties on the Local Authority whenever it is making any decision about a person with Care and Support needs. These are things that you absolutely must consider and are:

The impact on the person's individual wellbeing;
Whether any prevention service can be provided that will delay, reduce or prevent the need for Care and Support;
Whether information or advice can be provided to support the person to find their own solution, or to delay, reduce or prevent the need for Care and Support.

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 access information about the duty to promote individual wellbeing.

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

Click here to access information about the duty to provide good information and advice.

When a written referral is for a needs assessment

When you are making a decision about the appropriateness of a request for a needs assessment you must answer the following questions:

Is the person aged 18 or above?
Does the person have an appearance of need?

If you answer 'Yes' to both questions then a needs assessment is appropriate and the person is entitled to an assessment.

If the person does not have an appearance of need there is no duty under the Care Act to assess. However, you should still consider whether carrying out an assessment will still be of benefit to them in terms of the prevention, reduction or delay of any future need for Care and Support.

You must be satisfied that the person is happy with any outcome provided to them that is not a formal assessment if they:

Requested a formal assessment of need; and
The person has an appearance of need.

If the person is not happy and continues to request a formal assessment of need then the Local Authority has a duty under the Care Act to carry out such an assessment unless there is no appearance of need.

When a contact is for the Review or Revision of an Existing Care and Support Plan

Under the Care Act, when a person is already receiving Care and Support from the Local Authority they may request a review of their Care and Support Plan at any time and the Local Authority must consider the request. Where the request is deemed reasonable the Local Authority has a duty to review the plan.

See: Responding to a Review Request for further guidance.

3. A Strengths Based Approach

Wherever possible, every conversation with a person should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the person to explore whether there is:

Anything within their own power that they can do to help themselves; or
Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the person and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Authority intervenes with an assessment or other support, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

Taking a holistic view of the person or carers needs in the context of their wider support network;
Helping the person to understand their strengths and capabilities within the context of their situation;
Helping the person to understand and explore the support available to them in the community;
Helping the person to understand and explore the support available to them through other networks or services (e.g. health);
Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. It can be accessed here. Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

4. Ordinary Residence

What the Care Act says

Click here to read what the Care Act says about ordinary residence, including understanding what ordinary residence is, how/when to establish ordinary residence and how/when to meet the needs of people who are not ordinarily resident in the area.

To summarise, a person's eligibility for an assessment is not determined in any way by ordinary residence and is based solely on the appearance of need. Ordinary Residence must however be established before any eligible needs are met as the Local Authority only has a duty to meet the eligible needs of a person that is ordinarily resident in its area.

In practice, most Local Authorities will try to establish ordinary residence before carrying out an assessment, so that the assessment is carried out by the Local Authority that will subsequently be responsible for meeting eligible needs. However, an assessment cannot be declined on the basis that a person is not ordinarily resident in the Local Authority area.

How to proceed when it is clear that the person is not ordinarily resident

If, at the point of contact or written referral it is clear that the person is not ordinarily resident and an assessment by the Local Authority may not be in their interests or give them the outcome they are looking for. Information and advice should be provided to support the person (or the referrer) to understand ordinary residency and the benefits of having their non-urgent needs assessed by the Local Authority in which they are ordinarily resident:

That the Local Authority in which they are ordinarily resident will have a duty to meet their eligible needs (as opposed to a power in this authority);
That the Local Authority in which they are ordinarily resident will have a duty to carry out Care and Support planning with the person to determine the best way to meet eligible needs (as opposed to no duty to do so in this authority); and
That the Local Authority in which they are ordinarily resident will have a duty to review and monitor the effectiveness of the support provided to meet eligible needs (as opposed to no duty to do so in this authority).

Ultimately though, the person is legally entitled to have their needs assessed by this Local Authority if they want to. Information gathered during the assessment should be shared with the Local Authority in which they are ordinarily resident so that they can decide with the person how best to meet their non-urgent needs.

Click here to see the ordinary residence procedures, which include how to seek reimbursement for urgent needs met and any supporting documentation.

What to do when it is unclear whether the person is ordinarily resident in the area

Time should not be spent debating whether or not a person is ordinarily resident in the area if this is not clear. The person is entitled to an assessment of need based on an appearance of need, and not whether they are ordinarily resident. To delay the assessment whilst establishing ordinary residence would be unlawful.

The Local Authority should complete the assessment and establish ordinary residence after applying the eligibility criteria.

5. Clear and Unclear Outcomes

Clear Outcomes

If it is clear to you what further action is required, and you are authorised and confident to make this decision you should do so to avoid the person making the contact from any unnecessary delays in resolving their query/issue.

Unclear Outcomes

If it is not clear what further action is required or you are not authorised or confident to make this decision you should not commit to an action straight away. Instead, you should explain to the person making the contact that:

You need to consider all of the information and evidence before agreeing the action; and/or
You may need to discuss the action or seek advice from a manager or colleague with the appropriate expertise; and/or
You may need to gather further information from others (for example a health professional named by the person making contact).

In all cases you should:

Assure the person that their views have been heard and will be considered in any decision that is made; and
Agree with the person when they can expect to hear from you again.

Click here to access a tri.x tool that can be used to support decision making following a contact or referral.

Disputed Outcomes

If you are sure that the action being requested by the person making the contact is not appropriate you should be open about this in a respectful way.

You should:

Explain your reasons for thinking the action may be inappropriate;
Use professional expertise and evidence to support your rationale; and
Be able to provide at least one other option for the person to consider.

If you are in any doubt you should refer to the guidance in unclear outcomes above.

You should provide the person with any support they need to explore the other option (s) available to them and to weigh up the pros and cons of each. Where options have been provided to the person in writing this may need to be followed up with a telephone response to support the person to explore the options. Where the person appears to have difficulty communicating over the telephone consideration should be given to a face to face visit.

Where the action remains in dispute you must decide whether you are authorised and confident to make a final decision. If you are then you should do so. If not then you should follow the guidance set out in unclear outcomes above.

If the person is not happy with the outcome you must make them aware of their right to complain about it.

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.

6. Gathering Information and Consulting with Others

The purpose of gathering information and consulting with others

The purpose of consultation and information gathering is to ensure that the response of the Local Authority is a proportionate and appropriate one to the person's situation and level of need. Only information relevant to this purpose should be gathered and shared during consultation.

All information gathering and sharing should be carried out with regard to the Caldicott Principles and local information sharing policies.

Use the tri.x Resources tab to access further information about the Caldicott Principles in the glossary.

Click here to access the local Data Protection policy.

Methods of consultation

The method of consultation and information gathering used should reflect the individual circumstances of the case. Depending on the level of urgency, risk and need consultation and information gathering can be formal or informal in nature.

For example:

A telephone conversation;
An email or letter;
A video conference; or
A face to face meeting.

Where the method of consultation is not face to face you should be satisfied that the information you share will only be seen by the person to whom it is intended to be seen.

Where the Person has requested the Local Authority Gather Information or Consult

The Care Act is clear: Apart from cases where the level of risk is paramount you must consult with anyone that the person with Care and Support needs has asked you to consult with before making any outcome decision.

Examples of paramount risk could include:

Where urgent action is required, that if delayed to allow consultation would place the person at imminent risk of abuse or neglect leading to serious harm;
Where the person to be consulted is deemed to be the perpetrator of abuse and neglect and consulting with them at that time would place the person at imminent risk leading to serious harm;
Where urgent Care and Support provision is required, that if delayed to allow consultation would place the person at imminent risk of harm through the non-meeting of essential needs.

The person should be told why consultation has not occurred, and long term decision making should be avoided until such time when consultation is possible.

Consulting with carers

Where the person is known to have a carer the Care Act expects you to consult with them before making any decision regarding Care and Support for the person.

The purpose of doing so is:

To gather further information about the needs and situation of the person; and
To understand the needs of the carer and fulfil the duty to meet them.

Where the person with Care and Support needs has not consented to you consulting with their carer you must still do so for the purpose of understanding the needs of the carer. This will no doubt involve some discussion about the person with Care and Support needs but the Local Authority has a duty to support the needs of any carer it identifies and the person they care for cannot override this duty.

Consulting with Others

You should proactively identify anybody else that it may be appropriate to speak with in order to gather comprehensive information upon which to decide the most appropriate outcome. This could be a family member, a health professional, another Local Authority or an organisation (such as a Care and Support provider). Under the Care Act anybody contacted by the Local Authority has a duty to co-operate with any requests for information or support.

Click here to read more about the duty to co-operate under the Care Act.

Consent to Consult and Mental Capacity

With the person's consent, the Care Act permits the Local Authority to consult with anyone it deems relevant to consult with.

If there are concerns that the person may lack capacity to consent to you gathering information from or consulting with others then a mental capacity assessment must be carried out to determine whether this is the case. This should be carried out by the Local Authority because it is the Local Authority who wishes to consult.

If the person has capacity to consent following the mental capacity assessment their consent must be obtained before consulting others.

If the person lacks capacity to consent following the mental capacity assessment then a Best Interest Decision must be made to confirm that consulting with others will be in their Best Interests. This decision should be made by the Local Authority because it is they who will be consulting.

Click here to access the Mental Capacity Act 2005 Resource and Practice Toolkit, which contains guidance about assessing capacity and making best interest decisions.

Support can also be sought from team members, champions and the Mental Capacity Act Lead.

Note: All formal mental capacity assessments must be signed off by a manager.

7. Acting on Information about Risk

Information that a person may be at risk

If you have received information that indicates a person may be at risk of abuse or neglect you will need to consider the measures that you (or others) can take to protect them.

Where a safeguarding concern has not been raised already you should raise a concern without delay.

Click here to access the safeguarding adults procedures, including how to recognise abuse and neglect, how to raise a concern, how to record safeguarding information or adult safeguarding.

If the information suggests that there is a fire risk you should seek the consent of the person to make a referral to the London Fire Brigade for a free home fire safety visit and check. For further details visit www.london-fire.gov.uk/safety/the-home/.

Information that a person may be risky

If you have received information that indicates that a person may pose a risk to others you will need to consider the measures that you (or others) can take to reduce the risk and protect others.

Click here to access the procedure for carrying out a risk assessment.

If the risk assessment indicates that a vulnerable adult or child may be at risk of abuse and neglect you must ensure that you raise a safeguarding concern without delay.

Click here to access the safeguarding adults procedures, including how to recognise abuse and neglect, how to raise a concern, how to record safeguarding information or adult safeguarding.

8. Communicating the Outcome

The outcome of the contact or written referral should be communicated to the person about whom it relates at the earliest opportunity and by the most appropriate person. Often this is the worker who has been communicating with the person making the contact or referral throughout, but if a manager or another professional has been responsible for the outcome decision consideration should be given about whether it may be more appropriate for them to communicate the outcome.

The method of communication should reflect that requested by the person and any specific communication needs they may have. For the purposes of the Care Act communication about the outcome of a contact or referral is subject to the same requirements as the provision of information and advice, and the duty to make it accessible therefore applies equally.

Click here to read more about how to provide information in an accessible way under the Care Act.

Where communication is to be provided by telephone a follow up letter confirming the conversation and outcome should be sent to the person as a formal record.

When communicating the outcome you should include the following information:

The outcome itself;
The rationale for the outcome, including who has been consulted and what evidence has been used to reach any decisions;
Any information and advice relating to adult Care and Support, and the prevention, delay or reduction of needs;
Where further action or follow up action is required, what will happen next, including timeframes for further contact;
How to complain about any aspect of the outcome; and
What to do if circumstances change in the future.

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.

9. Recording Outcomes and Decision Making

Recording of decision making should be clear and comprehensive yet proportionate. Anyone reading the recordings should be able to (as quickly and easily as possible) understand what has happened and why a particular decision has been made.

When available it is important to capture in recordings:

The views of the person with Care and Support needs in regard to;
- Their needs and what they would/would not like to happen;
- The information and advice that has been given to them;
- Any verbal consent given to gather information or consult with others; and
- The possible outcomes that have been explored with them.
The views of any carer in regard to;
- The needs of the person;
- Their needs and what they would/would not like to happen;
- The information and advice that has been given to them;
- Any verbal consent given to gather information or consult with others; and
- The possible outcomes that have been explored with them.
The details of and views of any other person or organisation consulted with as part of the decision making process;
Details of any manager or peer supervision discussions that have influenced the outcome decision;
Any actions agreed with anyone, including how any follow up will take place;
Where there have been concerns about the person's mental capacity to consent to the contact or referral, to consent to consultation with others or to be part of the decision making; a record of how mental capacity has been assessed and how any best interest decisions have been made;
How the outcome has been decided, particularly how regard has been shown for individual Wellbeing, and how the decision prevents, delays or reduces the needs for Care and Support;
How the outcome has been communicated and how it was received; and
How the situation will be monitored for changes.

Recording should take place as near to the time that the actual event being recorded took place.

All recording should be in line with the Local Standards for Timeliness of Recording. The standards can be found in the Local Resources by clicking here.