Monitoring Urgent or Interim Support and Services

1. When to Use this Procedure

This procedure should be used whenever you are monitoring urgent or interim support that has been provided outside of a personal budget. This includes support provided to a person who is:

  1. Waiting for an assessment of need;
  2. Waiting for a reassessment of need;
  3. Waiting for a review of the Care and Support Plan; or
  4. Experiencing a short term change in circumstances.

This procedure should not be used when you are carrying out a statutory review of a Care and Support Plan.

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

2. The Purpose of Monitoring Urgent and Interim Support

The purpose of monitoring urgent or interim support is to:

  1. Ensure that the support is meeting urgent needs as intended;
  2. Establish that the urgent support being provided is still appropriate and proportionate to meet urgent needs;
  3. Establish the need for continued urgent support;
  4. Offer any information and advice to prevent, reduce or delay the need for Care and Support; and
  5. Gather any information to support prioritisation for assessment, reassessment or review.

3. Who should be Involved

In all cases

The monitoring of urgent and interim support should involve:

  1. The person with urgent needs;
  2. Any carer;
  3. Anyone else that the person requests is involved; and
  4. Anyone else that you feel needs to be involved (with the person's consent or in their best interests if they lack capacity).

When the person lacks capacity

When the person lacks capacity you must ensure that they are appropriately represented and that their involvement in monitoring activity is maximised.

You should consider:

  1. Who may be able to support them to be involved;
  2. The need to provide independent advocacy if there is not an appropriate person to support them to be involved;
  3. Consulting with others who may be able to provide information about how the urgent support is working for the person; and
  4. Using available evidence that can support you to understand the impact that the urgent support may be having on the person (for example ABC charts and other records that show behaviour changes clearly linked to the support).

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.

Monitoring when the person has substantial difficulty engaging

If a person does not lack capacity but does have substantial difficulty being involved in monitoring activity you must take all reasonable steps to ensure their involvement.

You must:

  1. Ensure that you have provided information in an accessible way, or that the person has an appropriate person to support them to understand it;
  2. Arrange to monitor the urgent support/service in an appropriate format so that it is accessible. This is likely to be face to face, unless the person's difficulty arises when engaging in face to face communication;
  3. Consider whether the person has an appropriate person to support their involvement and, if not, whether the advocacy duty applies.
Click here to access the advocacy procedures, including how to establish whether a person needs an advocate and how to make a referral.

4. Monitoring Urgent and Interim Support

When to monitor urgent or interim support

The urgent and interim support should be monitored to the timeframe that was agreed when it was arranged unless there is evidence that this is no longer appropriate or proportionate (for example if the person's urgent needs or circumstances have changed).

You should use supervision effectively to discuss and agree the need for continued monitoring.

Gathering information and consulting with others

When monitoring urgent support/services you should make effective use of any information that is available about:

  1. The effectiveness of the support being provided;
  2. The person's needs or circumstances.

Information could include:

  1. Records of contact with the person, carer or provider in between formal monitoring activity;
  2. Reports from professionals (for example a GP, Psychologist or Teacher);
  3. Records relating to safeguarding concerns or enquiries.

The method of monitoring urgent or interim support

The method of monitoring urgent or interim support should be proportionate to the nature of the support being provided, and the needs and circumstances of the person. It could include:

  1. Face to face visits to the person (required if they lack capacity);
  2. A meeting involving the person, any carer and the provider of the urgent support;
  3. Telephone contact with the person, any carer and the provider of the urgent support;
  4. Email communication.

The method of monitoring should be agreed with the person whose urgent needs are being met and any carer.

Recording monitoring activity

All monitoring activity should be recorded within the timeframes set out in the Local Standards of Timeliness of Recording. This can be found in the Local Resources area by clicking here.

In particular you should record:

  1. Whether the urgent support is meeting urgent needs as intended;
  2. Whether there have been any issues with the urgent support;
  3. Whether the person still has an urgent need for support;
  4. What other options have been discussed to meet urgent needs (from a strengths based approach);
  5. Whether any changes to monitoring activity are required.

Decision-Making

Whenever a decision is made to increase, reduce or continue urgent or interim support you must consider and record:

  1. The rationale for any decision made to continue, increase or reduce urgent or interim support/services;
  2. How you have given regard to the person's views and the impact of the decision of Wellbeing; and
  3. How you have given regard for the views of any carer.

5. Actions and Next Steps

Continuing urgent or interim support/services

If monitoring evidences a continued need for the same urgent or interim support/services you should:

  1. Check that funding arrangements are in place;
  2. Confirm on-going arrangements with the provider of the urgent support;
  3. Notify the Customer Financial Affairs Team (CFAT) (if the person is being charged and support is extended beyond the original timeframe agreed); and
  4. Agree future monitoring arrangements.

If funding is not in place to continue the urgent/interim support you should use the urgent and interim support procedure to request additional funding. Click here to access it.

Increasing urgent or interim support/services

If urgent or interim support/services are not meeting needs as intended and there needs to be an increase in support you should refer to the procedure for urgent and interim support, which includes how to decide which support to provide and how to request funding for urgent or interim support. It can be accessed by clicking here.

If funding is agreed you should:

  1. Confirm increased arrangements with the provider of the urgent support; or
  2. Make arrangements for urgent Care and Support with the provider;
  3. Notify the financial assessment service (if support is chargeable and the Local Authority intends to charge); and
  4. Agree future monitoring arrangements.

Reducing urgent or interim support/services

If urgent or interim support/services need to be reduced (for example if urgent needs have reduced or a carer is able to meet some needs) you should:

  1. Confirm new arrangements with the provider of the urgent support;
  2. Notify the financial assessment service (if the person is being charged for the support); and
  3. Agree future monitoring arrangements.

Changing the provider of urgent or interim support

If the monitoring conversation identifies that the current provider of urgent support is not working as intended you will need to:

  1. Explore the issues; and
  2. Wherever possible, reach an agreement about how best to resolve them.

This should be done in an open way using a strengths based approach and should involve:

  1. The person with urgent needs (or their representative if they lack capacity);
  2. Any carer; and
  3. The person or organisation to which the issue relates (unless doing so will put the person with care and support needs at risk of abuse or neglect).

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.

Ending urgent or interim support (where non-urgent needs exist)

If urgent or interim support/services are no longer required (for example if urgent needs no longer exist or a carer is now able to meet urgent needs) you should:

  1. End arrangements with the provider of the urgent support (click here to access the Commissioning and Brokerage Procedures as required);
  2. Notify the financial assessment service (if the person is being charged for the support);
  3. Agree future monitoring arrangements; and
  4. Explain to the person (or their representative if they lack capacity) what to do if their needs become urgent before any planned Care and Support process begins; or
  5. Where urgent support was being provided due to a change in circumstances, explain to the person what to do if their circumstances change again.

Ending urgent or interim support (where no appearance of need exists)

If the person's needs have changed to the point where there is no longer any appearance of need they are no longer eligible for Care and Support from the Local Authority.

In this case you should:

  1. Agree a date that the urgent support will end;
  2. Cancel the urgent service being provided;
  3. Provide information and advice about ways to reduce, prevent or delay the development of needs in the future;
  4. Notify the financial assessment service (if the person was being charged for the support);
  5. Explain to the person what to do if they have needs for support in the future; and
  6. Close the case.

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.

Reprioritising review, assessment or reassessment

There is a need to reprioritise the need for assessment, reassessment or review if:

  1. The person's needs have deteriorated or reduced;
  2. The person's situation has deteriorated or improved;
  3. The level of risk has increased or decreased (to the person or a carer);
  4. The person is at risk of abuse or neglect

Where this is the case you must clearly record what has changed and notify your line manager or the person responsible for prioritising allocations.

Consideration should then be given to the need to reprioritise allocation to carry out the required Care and Support function.

Need to Know
Where the information indicates there is also a need to reprioritise or request an assessment, reassessment or review regarding any carer with Support needs this must also be clearly recorded and considered.

Click here to access the procedure for allocating work, including when to allocate work and how to allocate.

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.

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

Prevention Services

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 (ACOT) service.

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