Deciding the Outcome of a Support Plan Review and Making a Formal Record (Carers)

1. Deciding the Outcome of a Support Plan Review

Possible outcomes of a review

Broadly there are 3 possible outcomes following review;

  1. No changes required to the Support Plan or personal budget; or
  2. Changes to one or more element of the Support Plan required but not to the personal budget (including changes to outcomes and the contingency plan); or
  3. Changes to the Support Plan and personal budget required due to a change in circumstance or need.

Deciding the outcome through the skilled conversation

Throughout the process of review you should talk to the carer and others about the likely outcome of the review, endeavouring to reach an agreement about this as the process progresses.

The responsibility for deciding the outcome

The Local Authority is responsible for making the final decision about the outcome of the review. As such this is your responsibility as you are the Local Authority's representative.

Considerations when deciding the outcome of the review

When determining the outcome of the review you must give regard to;

  1. The views of the carer about the outcome;
  2. The impact of the outcome on the carer's Wellbeing; and
  3. The views of anyone else consulted or involved in the review process.

The decision that you make about the outcome of the review must be evidence based and robust. This means you must be able to demonstrate the information that you have used to reach a decision if challenged.

The decision you reach may be in line with the views of the carer (and others) but equally it may not be if the evidence does not support that judgement. This is appropriate as long as you have a clear rationale for your decision and can demonstrate that you have given regard to the carer's views, their Wellbeing and the views of others.

Example:
During a combined review Ahmed explains that he does not think his mother is able to safely support him with transfers anymore. There have been no changes in Ahmed's needs and his mother has always managed his transfers in the past. Ahmed's mother explains that she has injured her shoulder and, while she can still support Ahmed to stand it can sometimes be painful to do so. Ahmed wants an increase in his personal budget so that he can arrange homecare. However, you know that there is currently no moving and handling equipment in place so you discuss the possibility of equipment to support with transfers and arrange to make a referral to Occupational Therapy. This is not the outcome that Ahmed wanted but the evidence suggests that the provision of equipment is the most proportionate response to try and resolve the current risk to Ahmed's mother.
Example:
Julie cares for her father Peter who has a degenerative health condition. She tells you that everything in her Support Plan is working well and there is no need to change anything. Julie's brother is part of the review with her consent and disagrees. He says that he has noticed a sharp deterioration in Peter lately that has meant that Julie's caring role has increased dramatically. He says that he is worried that she will not be able to sustain her role with the current levels of support and has already had to sacrifice social time with her children. From the evidence available you decide that the outcome of the review should be a proportionate reassessment to establish what has changed and what additional support Julie may need.

If you are unclear about the outcome of the review you should consider the benefit in gathering any additional information or consulting with any other person (with the carer's consent). If you remain unclear about outcome you should seek advice from your line manager about how best to proceed.

2. Managing Disagreement about the Outcome

There may be times when the carer or another person involved disagrees with the decision you have made about the outcome of the review.

In this situation you should be open to reviewing the available evidence and your rationale to ensure that the decision you have made is robust. You should be open and transparent about the evidence sources you have used and take steps to try and support the carer to understand the decision you have made.

Where ongoing disagreement persists you should;

  1. Seek the support and advice of your line manager as required;
  2. Make a record of any difference of opinion in the formal record of the review;
  3. Ensure the evidence upon which you have based your decision is robust;
  4. Make sure that the regard you have given to the views of the carer (and others) and the impact on their Wellbeing is clear; and
  5. Make proportionate records of any conversations you have had to try and resolve the differences.

You must also make the carer aware of their right to complain about the decision that has been made.

Click here to access information about the different ways a person can complain.

3. Making a Formal Record of the Review

You are responsible for establishing the current review framework used by the service for recording purposes. If you are unclear you should speak to your line manager before proceeding to make a formal record of the review.

The timeframe for making a record

The Care Act does not specify a timeframe for making a formal record of a statutory review only that this should be done in a timely way.

Timely recording will;

  1. Reduce the likelihood of inaccuracies;
  2. Prevent any unnecessary delays for the carer; and
  3. Ensure that any reassessment of need can make effective use of the information gathered at review.

If the timeframe for review that you use leads to inaccuracies or a delay in meeting needs then it is not timely.

What should be included in the record

The following information must be clearly but proportionately recorded in all cases;

  1. Whether the different elements of the Support Plan are in place and working as intended;
  2. Whether the carer's circumstances or needs have changed (and the evidence used to determine this);
  3. The carer's views about any changes to their needs or circumstance;
  4. Whether the outcomes in the plan have been achieved and whether the person has new outcomes they want to meet (with specific consideration for outcomes regarding work, education, training and recreation);
  5. Whether the plan is effectively reducing risk to the carer and the cared for person, and whether there are new risks to the person (for example from a change in need or from abuse or neglect);
  6. Whether the contingency plan in place is working;
  7. Whether the personal budget is still sufficient and enabling the carer to meet their needs and the outcomes identified in the plan;
  8. Whether the current method of managing the personal budget is working and still represents the best method for achieving outcomes (for example, should a Direct Payment be considered)?
  9. Whether there have been any changes to informal support that have impacted the plan (for example, can informal support to the carer be sustained or increased);
  10. What information and advice has been given to prevent, reduce or delay the need for further Support; and
  11. The overall outcome of the review and next steps agreed (including the rationale for the outcome decision and the proposed timeframe for the next review).

The following information should be clearly recorded where relevant;

  1. Where the carer's needs or circumstance have changed; what the changes are and what the impact is on Wellbeing (including the carer's views and the views of any carer);
  2. Where elements of the plan are not working what steps have been agreed to resolve any issues (from a strengths based approach);
  3. Where outcomes have not been achieved, steps that are to be taken to support the carer to achieve them (including any changes required to the plan);
  4. If the carer has new outcomes, how the plan will support them to be achieved;
  5. If the plan is not reducing risk, what changes are required to the plan to reduce risk;
  6. If the contingency plan is not working, what changes are needed to it;
  7. Where the carer's needs have changed; whether urgent or interim support needs to be provided;
  8. Any safeguarding concerns that have been raised and action taken;
  9. Any Deprivation of Liberty concerns raised and action taken;
  10. Any difference in views about the outcome of the review.

Providing a copy to the carer

Following the review process the carer must be given a written record of their review.

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

It is important that the carer understands their review and the outcome of it. To this end it should be provided in a format that is accessible to them.

If the review record has been provided in a format that you know or suspect the person will not be able to understand you should;

  1. Consider any steps that you can take to support them to understand it (for example talking through the review over the telephone or summarising it in a simpler format); and
  2. Consider the duty to make an independent advocate available.

If an advocate is already involved they should be informed when the review has been provided to the carer so that they can support them 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 review must be made available to the other person that carried it out with you.

In all other cases a copy of the record can only be shared with any other person with the carer's consent.

If the carer consents a copy of the review should be shared with any service provider who was involved in the review and is responsible for providing Support to the person.

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

Concerns about a request

Sometimes the carer will request a copy of the review is provided to a person who was not involved in the process. You must provide a copy of the review to anyone that the person requests you to unless you are concerned that doing so could put the carer, the person they care for 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 a vulnerable adult or child at risk; or
  3. To decline to provide a copy of the record (although the carer can of course still choose to make a copy available from their own record).

Amending a review record

Sometimes the carer or anyone else that was involved in the review may ask for amendments to be made to the record. For example;

  1. They feel that there is information missing; or
  2. They feel that the record is a misinterpretation of something that was said or agreed.

In this case you should;

  1. Consider the request;
  2. If the carer whose review it is has not made the request, consult with them; and
  3. Review any evidence or information you have which may support or refute the request.

You should not make the amendment regardless of the existence of evidence and a rationale for doing so. If you reach a decision not to amend the record you should be clear about your reasons for not doing so, and you should make the carer aware of their right to complain about your decision.

If a decision is made to make the amendments you should proceed to do so. Where doing so results in 2 versions of the same review being available on the system it must be clear which the amended version is.

The amended record should be circulated to the same people as the original record, unless the carer requests otherwise or there is evidence that doing so would put the carer or a vulnerable adult or child at risk of harm or abuse.

4. Actions and Next Steps

When there are no changes required to the plan or the personal budget

If both the Support Plan and the personal budget remain unchanged following a statutory review the plan does not require further sign off. However, it should be clear from the plan;

  1. That it remains unchanged; and
  2. When the next statutory review date is.

In all other cases

Depending on the outcome of the review there could be a range of further actions required. Examples of what this could include are;

  1. Revision of the Support Plan within the existing personal budget;
  2. A proportionate reassessment of need of the carer or the cared for person;
  3. The provision of urgent or interim support to allow for a reassessment of need to take place or in response to a short term change in circumstance;
  4. The provision of information and advice to support the meeting of outcomes, reduce risk  or prevent, reduce or delay needs;
  5. Referral to a preventative service (for example occupational therapy, health or housing);
  6. Reporting concerns about a service provider.
You can access the procedure to carry out all possible actions by clicking here.