Legal Requirements of a Support Plan Review and Tools (Carers)

1. The Purpose of a Support Plan Review

The Support Plan/Care and Support Plan review is the primary monitoring function of the Care Act. It is vital that reviews are carried out to ensure that the duty to meet eligible needs is being met on an on-going and continuing basis.

The purpose of a Support Plan review

The Local Authority has a statutory duty under section 27 of the Care Act to;

1. Keep Support Plans under general review (using the timescales set out in the Act); and
2. Review the Support Plan upon any reasonable request to do so.

Under the Care Act the purpose of a Support Plan review is to;

1. Reflect on what is working and not working about the Support Plan;
2. Consider what may need to change about the Support Plan;
3. Make sure the plan remains up-to-date;
4. Make sure the plan remains relevant to the carer's needs and identify any need for reassessment;
5. Make sure the plan remains relevant to the carer's aspirations; and
6. Mitigate the risk of the carer entering a crisis situation; and
7. Mitigate any risk to the person with Care and Support needs from abuse or neglect.

What the Support Plan review must establish

There are particular broad elements that you must establish when carrying out a Support Plan review;

1. Have the carer's circumstances and/or Support needs changed?
2. What is working in the plan, what is not working, and what might need to change?
3. Have the outcomes identified in the plan been achieved or not?
4. Does the carer have new outcomes they want to meet?
5. Could improvements be made to achieve better outcomes?
6. Is the carer's personal budget enabling them to meet their needs and the outcomes identified in their plan?
7. Is the current method of managing the personal budget still the best one for what they want to achieve?
8. Is the personal budget still meeting the sufficiency test?
9. Are there any changes in the carer's informal and community support networks which might impact negatively or positively on the plan?
10. Have there been any changes to the needs of the person being cared for which might mean they are at risk of abuse or neglect?
11. Is the carer satisfied with the plan?

2. Legal Requirements of Review

Timing of a Support Plan Review

The review should be carried out in a timely way, based on the needs and circumstances of the carer. Because every carer is different, the Care Act does not specify the frequency in which a Support Plan review must take place. That said, the statutory guidance does expect the Local Authority to endeavour to carry out a Support Plan review as follows:

1. A review of a new service or Support Plan should be carried out within 6-8 weeks of the service/change commencing;
2. A review of an on-going stable 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 carer'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).

Who must be involved in a review

Whenever you carry out a review you must involve;

1. The carer with Support needs;
2. Anyone else that the carer has asked you to involve;
3. The carer's representative (when they have substantial difficulty).

The timing of a Direct Payment review

1. Where the carer is managing part or all of their personal budget with a regular Direct Payment an initial review of the Direct Payment must be carried out no later than 6 months after the first payment is made; and
2. Further reviews of the Direct Payment must take place no less than every 12 months.

Combining a Direct Payment Review with a Support Plan Review

Wherever possible there is an expectation under the Care Act that a Support Plan review and a Direct Payment review are carried out at the same time, preferably as a joint process. Doing so will prevent unnecessary duplication for both the carer and the Local Authority.

Click here to access the Direct Payment review procedure.

Who can carry out a review

Although not strictly required, the person carrying out the review should meet the requirements of a person who carries out an assessment. This is so that the person has the necessary expertise to recognise when a reassessment may be required. In summary, these are that they should be:

1. Competent to carry out the function; and
2. Possess the skills, knowledge and competence required based on the carer's needs and circumstances (for example being skilled to adapt communication appropriately).

The responsibility of review

Under Section 27 of the Care Act 2014, the Local Authority must keep 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 carer whose plan it is.

3. Tools and Practice Guidance for Review

General practice guidance

These procedures contain comprehensive general practice guidance to support an effective review process.

Legal Requirements and Statutory Guidance

The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the review process, but it does acknowledge that a good tool can be helpful. However, any tool should;

1. Facilitate and ensure the carer's involvement;
2. Support the information gathering process;
3. Be flexible and adaptable; and
4. Be appropriate and proportionate to the needs being met by the Support Plan.

See below for details of the tools that are available for you to use as required.

Considerations when using tools

The process of review involves having a skilled conversation about;

1. What is working/not working;
2. What may have changed about the carer's situation, needs or outcomes; and
3. What may need to change in the Support Plan as a result.

Depending on the nature of the review and the presenting issue there may be a need to explore in more detail;

1. Changes in Needs; and
2. Risk.

You should consult with the carer when arranging the review to understand the specific communication needs that they have so that any review tool you use will ensure their involvement in the conversation.

If you not feel that the review tools available to you will be appropriate you should speak to your manager about how they can be adapted.

Available tools

Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of review. These are known as tools.

The following are tools available to you that may enhance any review conversations and accessibility.

Click here to access a range of tri.x person centred tools that can;

1. Support a carer to think about what matters most to them, now and in the future;
2. Support a carer to think about Wellbeing;
3. Support a carer to think about needs and what a good day/bad day looks like; and
4. Support a carer to think about what is working/not working about a Support Plan and any services or support they receive.

The Local Authority subscribes to Research in Practice for Adults (RiPfa) who provide a range of tools and resources to support skilled conversations.

RiPfa can be accessed by clicking here.

If you have difficulties accessing the resources speak to your line manager.

4. Light Touch Review

The Care Act expects a light touch review to be carried out whenever this is deemed appropriate.

The primary focus of a 'light touch' review is to gather enough information to be satisfied that the Support Plan is working effectively as intended with no issues or adjustments needed.  During a light touch review there is only a requirement to 'touch' upon needs, Wellbeing and outcomes, unless doing so identifies the need for a more explorative conversation.

A light touch review is less intrusive for the carer and avoids unnecessary duplication or repetition of information recently provided. The recording of a light touch review should also be more proportionate.

A light touch review is normally appropriate and proportionate whenever;

1. There are no known changes in need or circumstances; and
2. There are no changes required to a Support Plan (or minimal changes to how existing Support is provided only); and
3. There are no changes required to the personal budget.

A light touch review should be specifically considered in the following circumstances;

1. At the 6-8 week review; and
2. When there is/has been on-going monitoring of the carer's needs or circumstance.

5. Refusal of a Review by the Local Authority

Who can request a review

Anybody can make a request for a Support Plan to be reviewed and the Local Authority must consider all requests made. There is a duty to carry out a review whenever a request is deemed 'reasonable'.

Deciding whether a review request is 'reasonable'

Any request for a review that is made at a time reflective of that recorded in the Support Plan is usually reasonable. If these are the circumstances of the request a review should be arranged and carried out at the earliest opportunity.

Deciding whether a review request made at any other time is 'reasonable' involves considering a number of factors before making a professional judgement. These include;

1. Is the information on which the request is being made accurate?
2. If a review has been carried out in the last 6-8 weeks, has there been a change in need or circumstance?
3. Is the Support Plan still working as intended?
4. Are the eligible needs identified at assessment being met?

The need to consult with the carer

The carer whose Support Plan it is must be consulted before any decision is made about the need to review, and their views must be regarded.

When a review is deemed 'reasonable'

If the review is deemed reasonable you should make arrangements to carry it out at the earliest opportunity, using these procedures.

When a review is deemed 'unreasonable'

There is no duty to carry out a review if the request is deemed 'unreasonable'.

If the decision is made not to carry out a review you should inform the carer whose Support Plan it is, and the person who made the request (if this was a different person) as soon as possible.

You should explain;

1. That the review request has been declined;
2. The evidence upon which the decision was made;
3. When a planned review will be carried out;
4. What the carer should do if their needs or circumstances change before then; and
5. The carer's right to complain about the decision.

You must also provide information and advice about;

1. Adult Care and Support in general as required;
2. Ways that needs could be prevented, reduced or delayed.

In all cases where communication has been provided by telephone a follow up letter confirming the conversation and outcome should be sent to the carer as a formal record.

The general Local Authority letter template should be used for this purpose. Click here to access available templates.

You should also make a proportionate record of the decision, the carer's views and the information that has been given to them, specifically any timescales that have been agreed.

Monitoring the situation

A proportionate response to a review request may be to agree monitoring arrangements.

There is a duty under the Care Act to carry out proportionate monitoring whenever there is a risk that a carer's needs may change or their situation may become unstable.