Actions and Next Steps (Occupational Therapy)

1. Providing Information and Advice

The Local Authority has a duty under section 4 of the Care Act to provide good general information and advice relating to adult Care and Support wherever it is requested or would be of benefit. This duty applies equally in respect of all local residents regardless of whether the person with Care and Support needs is known to, lives in, or is already receiving services from the Local Authority.

Click here to read more about the duty to provide information and advice under the Care Act, including how information and advice should be provided and the specific information and advice requirements around finances.

Information and advice about adult Care and Support can be accessed in a number of ways:

1. To access information online go to www.croydon.gov.uk/healthsocial/adult-care.
2. To access information over the telephone call 020 8726 6000 or 6500.
3. To access information in person visit Access Croydon, Bernard Weatherhill House, 8 Mint Walk, Croydon, CR0 1EA.

Click here to see the answers to some frequently asked questions around financial assessment, including questions relating to Disabled Facilities Grants.

Note: This FAQ is based on statutory duties and powers and does not reflect Croydon Councils policy to provide all carers services on a non-chargeable basis.

The Customer Financial Affairs Team also have a Charging Helpline open between the hours of 9-5 Monday-Friday. The number is 020 8760 5676.

The following local organisations are also able to provide general information and advice relating to adult Care and Support;

Advice Services Croydon
020 8686 0066
asc@adviceservicescroydon.org.uk
directory.ageukcroydon.org.uk/

Disability Croydon
50 High Street
Croydon
CR0 1YB
020 8688 3622
dcsupport@disabilitycroydon.org.uk

Citizens Advice Bureau
48-50 Portland Road
South Norwood
London
SE25 4PQ

1. Drop In for advice Tuesdays, Wednesdays and Thursdays 10am-12 noon;
2. Online Advice Service (www.citizensadvicecroydon.org): Fill in the online form to request advice;
3. Telephone advice line: 020 8684 2236, available Monday and Friday 12 noon -2.30pm and Wednesday and Thursday 10am -11.30am;
4. Advice online at the website on a range of matters, including benefits, work, debt, housing, law and rights, healthcare, etc (www.citizensadvicecroydon.org/);
5. Access Croydon can also process a referral to the Citizens Advice Bureau.

The following local organisations can provide more bespoke information and advice.

Sometimes it is helpful to contact a well-known national organisation with a dedicated information and advice service or help-line. Click here for details of some national organisations offering this service.

Some national organisations do not have dedicated information and advice services but can still provide such support upon request. Click here for a wider range of useful national contacts for adult Care and Support.

Information and advice must be provided in an accessible way so that the person for whom it is intended can best understand and make use of it.

If you feel the person for whom the information and advice is intended will need support to understand it then you should:

1. Consider whether the person has anyone appropriate who can help them to understand it;
2. Consider any steps that you can take to support them to understand it (for example talking through the information over the telephone or summarising it in a simpler format); and
3. Consider the benefit of independent advocacy.

Information and Advice about Equipment and Adaptations

Information and advice may be required about local options available for a person to meet their needs in relation to equipment and adaptations (whether or not an assessment of need is going to take place). The following is a list of local services that specialise in providing equipment and adaptations;

The following are local organisations able to provide this advice;

Community Equipment Service
Croydon Living Independently Centre
3 Imperial Way
Croydon
CR0 4RR

Email: cesadmin@croydon.gov.uk
Phone: 020 8664 8860
Visit the website www.croydon.gov.uk/health-and-wellbeing/community-equipment-service-ces

NRS Healthcare
www.nrshealthcare.co.uk/
0345 121 8111
Email for advice: productadvice@nrs-uk.co.uk

Ask Sara
Ask Sara is a website providing interactive live equipment advice at croydon.livingmadeeasy.org.uk.

Note: Whenever you signpost someone to any of the above you must also advise them of their right to an assessment by the Occupational Therapy service, and that if they are eligible for support equipment up to the value of £1000 is non-chargeable.

2. Following up on Information and Advice

Under the Care Act the Local Authority has a duty to not only provide information and advice where it is needed, but to ensure that the information and advice it provides has been effective.

Therefore, when information and advice has been provided you should make appropriate arrangements to follow up with the person to whom it was given in order to review how effective it has been.

The timescales for this follow up should be agreed with the person to whom the information and advice was given and should reflect the individual circumstances and level of risk.

Where you are making arrangements for someone else to follow up on the information and advice you have given (rather than following up on it yourself) you must make sure that you have recorded this in a way that will ensure the person follows up on it at the agreed time.

3. Accessing another Prevention Service

Under Section 2 of the Care Act the Local Authority has a duty to prevent needs for Care and Support/Support whenever it identifies an opportunity to do so.

Click here to read more about the duty to prevent needs for Care and Support, including the types of prevention services recognised by the Care Act, when to provide prevention services and how to charge for prevention services.

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.

Occupational Therapy is one of a range of services available where the focus is on the prevention, delay or reduction of needs and a person may benefit from more than one prevention service at the same time.

In this case you should take steps to support the person to access the service they need.

Use the links below to find out about different prevention services available and how to access them.

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 health and wellbeing service Just Live Well.

4. Taking a Referral for Assessment (Duty OT)

If during a telephone contact you gather information that suggests the person would benefit from further assessment or intervention a referral should be taken so long as:

1. The person the referral relates to is making the referral;
2. The person the referral relates to has given their consent to the referral; or
3. The person that the referral relates to lacks mental capacity to make a referral and a decision has been made under Best Interests that a referral should be made; or
4. The person that the referral relates to is at risk of harm from abuse or neglect.

The following information should be included in the referral:

1. All personal details, including the persons full name (and also preferred name or previous surname), address and preferred contact details, date of birth, national insurance number and NHS number;
2. The name, relationship and contact details of the person making the referral (if not the person themselves);
3. When and how the person consented to the referral;
4. If the person has not consented to the referral, was a mental capacity assessment carried out and is the referral being made under Best Interests;
5. What the presenting issue is from the person's perspective and what they would like to happen;
6. What the presenting issue is from the referrer's point of view (if the referrer is not the person) and what action they may recommend;
7. What options have been considered with the person to resolve the issue so far, including what support the person has had from family and community networks;
8. What information and advice has been provided to the person or what information and advice may be required;
9. What prevention services have been used, considered or may be of benefit;
10. Any specific communication needs of the person that need to be considered so they can understand and be involved in any adult Care and Support process;
11. Whether the person is likely to have substantial difficulty in any adult Care and Support process, and if so whether an independent advocate has been considered;
12. Details of any previous or current Care and Support services (whether the Local Authority is providing them or not);
13. With the person's consent the name and contact details of anyone involved in their life who should be involved in any assessment (family member, friend or professional); and
14. Any other information deemed relevant by the person or referrer (if the referrer is not the person).

5. Providing Information about a Person

The Local Authority has a common law and legal duty to safeguard the confidentiality of all personal information. As an employee of the Local Authority you are bound contractually to respect the confidentiality of any information that you may come into contact with. Under no circumstances should such information be divulged or passed to any persons or organisation in any form unless you have authorisation to do so.

All information sharing that takes place must be in line with data protection legislation (namely the UK General Data Protection Regulation and the Data Protection Act 2018) and local policy.

The Caldicott Principles must also be regarded. The Caldicott Principles are a set of principles that apply to the use of confidential information within health and social care organisations and when such information is shared with other organisations and between individuals, both for individual care and for other purposes. For further information, see: The Caldicott Principles.

Any unauthorised disclosure of confidential information may result in disciplinary action of individual prosecution under the Data Protection Act 2018.

For further information and guidance, see: Providing Information about a Person or Carer.

6. Transferring a Contact

It is important that the person making contact speaks to the right practitioner at the right time.

Transferring a telephone contact

Requests to speak to a named practitioner

When the person making the contact requests specifically to speak to or be contacted by a particular person you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the person is allocated to the practitioner they have requested to speak to.

You should not transfer a telephone call to a named worker if it is clear that the worker is not allocated to the person. This will not be helpful to the worker or to the person as they will not be speaking to the right person to resolve the contact.

Transferring a contact

All transferring of calls should take place in line with the Local Communication Protocol. This is available in the Local Resources area by clicking here.

Unallocated/unknown cases

If the person does not have an allocated worker, all contact should be managed by the Duty OT.

What to do if the practitioner the telephone contact is being transferred to is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If you know when the practitioner is likely to become available you should:

1. Inform the person of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and confirming the information given to the person about when to expect a call back;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required should the practitioner be unavailable for more than a few hours;
4. Agree with the person what they should do if the practitioner does not make contact at the expected time; and
5. Make a proportionate record of all the above.

If it is not clear when the practitioner will become available, or if an urgent response is required you should:

1. Inform the person of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and what information has been given to the person/carer;
3. Undertake any urgent actions (Duty OT); or
4. Request the Duty OT undertake any urgent actions (other ACOT workers); and
5. Make a proportionate record of all the above.

Transferring a written, email or text contact

Contacts for a named practitioner

When a written contact is addressed to a named worker you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the person is allocated to the practitioner they have addressed the written contact to.

You should not transfer a written contact to a named worker if it is clear that the worker is not allocated to the person. This will not be helpful to the worker or to the person as they will not be dealing with the right person to resolve the contact.

Transferring the contact

Before transferring the contact you should:

1. Confirm that the practitioner the written communication is being transferred to is available within a reasonable timeframe for the action indicated by the contact, or that you have agreed with a manager how the contact will be managed;
2. Where the communication is a letter or an email, whether the practitioner wishes to receive the original contact (if not this should be filed securely); and
3. Where a written response confirming the contact has been received is required or requested, agree who will provide this.

The most secure way to transfer a written contact is to send a message to the practitioner alerting them to the contact and where it can be found on the recording system.

Any original copies of emails must be sent via internal secure email systems only and any original letters must be sent via internal postal services or secure delivery only.

Click here to access the local Data Protection policy.

Unallocated/unknown cases

If the person does not have an allocated worker, all contact should be managed by the Duty OT.

What to do if the practitioner the written contact is being transferred to is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a colleague or manager who may know.

If the practitioner is not available within a reasonable timeframe for the action indicated by the contact you should:

1. Inform the person/carer of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and what information has been given to the person/carer;
3. Undertake any urgent actions (Duty OT); or
4. Request the Duty OT undertake any urgent actions (other ACOT workers); and
5. Make a proportionate record of all the above.

7. Safeguarding Concern

Where the information gathered requires further action under safeguarding 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.

8. Using Independent Advocacy

The Advocacy Duty

Whenever the outcome of a contact or referral is that the person will be involved in any adult Care and Support process (including any assessment, or safeguarding) the Local Authority has a duty under the Care Act to make an independent advocate available to the person when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the person would experience substantial difficulty being fully involved in the Care and Support process without support.

Click here to see a tri.x tool that can support effective and consistent decision making about when/which advocacy support should be made available.

The Local Authority also has a power (but not a duty) to make advocacy available in other situations on a case by case basis if it deems this appropriate and is able to do so. This could include advocacy to support a person to understand information and advice, or advocacy to support a person to explore possible options available to them.

The Difference between substantial difficulty and lacking mental capacity

Having substantial difficulty is not the same as lacking mental capacity.

Click here for information about how to determine substantial difficulty.

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

An appropriate person

An appropriate person for general representation purposes is not the same as an appropriate person for independent advocacy under the Care Act.

Click here for information about the difference and how to establish whether there is already an appropriate person.

The role of the Independent Advocate

The role of an independent advocate appointed under the Care Act is not the same as the role of a general advocate or any other type of advocate (for example an Independent Mental Capacity Advocate or an Independent Mental Health Advocate).

An independent advocate appointed under the Care Act must both facilitate and ensure the involvement of the person with substantial difficulty in the Care and Support process that is taking place.

For information about the ways in which an independent advocate should fulfil their role click here.

Advocacy for people who lack Capacity

People who lack capacity will likely be legally entitled to advocacy under both the Care Act and the Mental Capacity Act 2005.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or whether any important decisions are likely to be the outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

Use the tri.x Resource tab to access information about the role of an Independent Mental Health Advocate (IMHA) in the glossary.

Click here to access a tri.x tool that can support effective and consistent decisions about when/which advocacy support should be made available.

Advocacy for people subject to the Mental Health Act

People eligible for an Independent Mental Health Advocate (IMHA) under the Mental Health Act 1983 will likely be entitled to advocacy under the Care Act.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or the likely outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

Use the tri.x Resource tab to access information about the role of an Independent Mental Health Advocate (IMHA) in the glossary.

Click here to access a tri.x tool that can support effective and consistent decisions about when/which advocacy support should be made available.

Making a Referral for Independent Advocacy

The advocacy referral can be made at any time and should be made without delay as soon as the duty applies, even if the service making the referral will not be the service carrying out the Care and Support process. The Care and Support process requiring advocacy support cannot begin until it is in place.

Advocacy for All

Advocacy for All are commissioned to provide a full range of advocacy services in Croydon, including:

1. Care Act advocacy;
2. Independent Mental Capacity Act advocacy (IMCA);
3. Independent Mental Health Act advocacy (IMHA);
4. NHS complaints advocacy;
5. General advocacy for people with a learning disability;
6. General mental health advocacy;
7. DoLS advocacy;
8. Acting as a Responsible Person's Representative (RPR).

MIND

If Advocacy for All does not have capacity to provide the required service MIND should be used.

Family Justice Centre

The Family Justice Centre provide an Independent Domestic Violence Advocacy service (IDVA).

Age UK

Age UK can provide an advocacy service for older people where there are concerns around financial abuse.

Out of borough advocacy

If the person requiring advocacy has been placed by Croydon out of borough you should contact the relevant Local Authority to identify their locally commissioned advocacy provider and arrange an advocate from this service.

Recording advocacy

When advocacy is arranged the name of the advocate should be recorded on LAS using the most appropriate relationship type.

What to do if Independent Advocacy is not available or delayed

Regardless of whether or not independent advocacy is available in the local area the duty to provide it still applies. A failure to do so is a breach of this duty and of the law. It is the role of commissioners to ensure that advocacy services are in place and available when required, and it is the role of practitioners to make timely referrals to advocates to prevent unnecessary delays in the meeting of its duty.

If you are aware that advocacy support is required and is not yet available you must not proceed to carry out any Care and Support process until it is in place.

In some circumstances urgent interim measures may need to be agreed without an advocate in place in order to reduce immediate risk to the person from inaction. However, Care and Support processes that will decide long term and important decisions must not be carried out without advocacy support.

Click here to see the procedures for providing urgent support, including access to a tool to support consistent decision making in determining urgent needs.

What to do if the person does not want to use advocacy

The duty upon the Local Authority is to make independent advocacy support available to any person who requires it. Once made available the duty is met.

If a person decides that they do not wish to engage in the advocacy support that has been made available to them they do not have to do so, but the Local Authority must still provide it.

9. Maintaining Existing Equipment

All equipment repair requests go through Croydon Equipment Services (CES). This is regardless of how the equipment was originally provided. CES will then arrange to carry out the repair/replacement or liaise with the equipment manufacturer if under warranty.

You should seek support from a line manager if you are unfamiliar with the process for making an equipment repair request.

If the equipment was provided to meet a person's eligible need (rather than under the duty to prevent, reduce or delay needs) you must remain mindful that meeting eligible needs remains the duty of the Local Authority. As such you may need to arrange for interim equipment or an alternative measure to meet the need whilst equipment maintenance is carried out.

10. Direct Support

Direct support refers to the range of ways that an Occupational Therapy practitioner works directly with a person or a carer to ensure safe and effective use of equipment, aids or an adaptation.

Direct support includes:

1. Training of informal and paid carers in the safe and proper use of equipment; and
2. Supporting the person to safely and confidently use equipment or adapt to their environment after an adaptation.

Direct support:

1. Builds the person's confidence to use equipment and access their adapted environment;
2. Builds the confidence of any carers to use the equipment;
3. Ensures that people using the equipment are suitably skilled to do so;
4. Ensures that people using the equipment know when it may be faulty;
5. Reduces the risk of unsafe use of the equipment;
6. Reduces the risk of injury from unsafe or improper use of the equipment;
7. Maximises the effective use of the equipment or adapted environments to promote independence or prevent, reduce and delay needs.

11. Assessment without Allocation (Duty OT)

The Duty OT can undertake a telephone assessment prior to allocation when:

1. The needs are clear;
2. The risk is immediate;
3. The equipment does not require installation;
4. The equipment does not require or adaptation to the person's height, weight etc;
5. There is minimal risk involved to the person or their carer in using the equipment; and
6. The equipment is readily available.

An example would be where a person is having difficulty getting to the toilet and it is clear that the provision of a commode would be beneficial.

In all instances when equipment has been provided following a telephone assessment the Intake Team should be asked to follow up and undertake any further assessment that may be required.

12. Allocation for Assessment or Support

Deciding where to allocate (Duty OT)

The Duty OT should use their clinical judgement (with support from the Senior OT) to determine which of the ACOT teams is best placed to undertake the assessment or support required.

Intake Team

1. Assess where there are difficulties carrying out functional tasks;
2. Short term intervention likely;
3. Assessment is urgent;
4. Moving and handling;
5. Advice on equipment to support Out of Borough hospital discharges;

Long Term Team

1. The person has a long term or degenerative condition;
2. Longer term intervention likely;
3. Equipment or simple/one-off adaptation likely.

Major Adaptations Unit (MAU)

1. Major adaptation requiring structural change to home.

If it is not clear which team should be allocated the case should be passed to the the Intake Team for further assessment.

Prioritising Allocation to a Practitioner (ACOT Teams)

Allocation by teams should take place in a timely way so as to:

1. Avoid any unnecessary delays to the person;
2. Reduce the risk of a deterioration in the situation; and
3. Maximise the use of measures that will prevent, delay or reduce needs.

Where there are a significant number of people awaiting allocation for further work or assessment there should be a fair and consistent prioritisation process in place that takes into account:

1. The level of risk;
2. The level of need;
3. Current support in place and the sustainability/effectiveness of this;
4. The urgency;
5. The likelihood of deterioration; and
6. The potential for fluctuation.

Note: Cases should be prioritised on the factors above, and not by the nature of a person's previous involvement with the ACOT team.

An element of monitoring should be incorporated into any allocation process to ensure that teams remain aware of every person's situation and are able to respond appropriately to any changes or need to re-prioritise allocation.

Delays in Allocation

If a person is likely to remain unallocated for some time teams must consider whether:

1. There is appropriate support in place to meet any needs that they appear to have in the interim (either though a carer or an existing Care and Support Plan); and
2. If not, the steps that need to be taken to ensure any urgent needs are met.

If there are unmet urgent needs teams must take steps to ensure that these are met.

If a practitioner from a social work service is already involved with the person teams should:

1. Inform them that allocation has been delayed and that the person appears to have unmet urgent needs;
2. Advise them of a possible timeframe for allocation; and
3. Provide them with access to any information gathered through contact or referral so they can prioritise and consider the most appropriate course of action.

If the person is not known to a social work service teams will need to make an urgent referral/request to the appropriate social work team.

How to allocate

The Care Act recognises that each worker (regardless of whether or not they have a professional qualification) will possess specific skills, knowledge and experience that will enable them to carry out different Care and Support functions or work with particular people well.

Because of this there is no expectation that a particular role should carry out a particular function; instead the Local Authority should allocate tasks to the most appropriate person for the job.

Allocation decisions should take into account:

1. The skills, knowledge and experience of the worker in carrying out the function or process required;
2. The skills, knowledge and experience of the worker in working with the particular needs of the person (for example health needs or communication needs); and
3. The views and wishes of the person themselves in relation to the skills required of the worker and who they feel would best support them.

Click here to access a tri.x tool that can support consistent decision making when deciding who to allocate work to.

Note: If the case has only recently closed to a worker consideration should be given to re-allocating. However this should not result in inequitable allocation processes for people with similar needs and priorities.