Preparing to Carry out a Support Plan Review (Carers)

1. Letting the Carer know you will be Carrying out the Review

General Guidance

You should let the carer know as soon as possible that you will be carrying out the review, even if you are not able to make the arrangements to do so yet.

The method of communication should reflect that requested by the carer and any specific communication needs they may have. For the purposes of the Care Act communication about the review 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.

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 it.

Arranging a review

If you are able to make arrangements for the review to be carried out you should do so. Click here to access the procedure for arranging a review.

If you are unable to arrange the review yet

If you are not able to arrange the review at this first contact you should;

1. Be satisfied that the delay is not going to increase the risk of deterioration in need or circumstances of the carer or the person they support;
2. Be satisfied that the delay is not going to increase the risk of abuse or neglect of the person the carer supports;
3. Provide any information or advice that may be beneficial at that time;
4. Be satisfied that urgent or interim support is not required;
5. Be satisfied that the carer understands the reason for the delay;
6. Agree a proposed timeframe for the review to be carried out and further contact to be made; and
7. Advise the carer what to do should their situation change.

An element of monitoring should be incorporated into any delayed process to ensure that you remain aware of the carer's situation and are able to respond appropriately to any changes or need to re-prioritise their review.

If the timeframe for review agreed with the carer changes you should let them know as soon as possible. If you experience difficulties prioritising your own work you should seek support from your line manager.

If the carer is not happy about any delays and you are satisfied that you are taking all reasonable steps to make arrangements and reduce risk you must make them aware of their right to complain.

2. Engagement Difficulties

Review when the carer has substantial difficulty engaging

If a carer has substantial difficulty being involved in any Care and Support process 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 carer has an appropriate person to support them to understand it;
2. Arrange to carry out the review in an appropriate format so that it is accessible. This is likely to be face to face, unless the carer's difficulty arises when engaging in face to face communication;
3. Consider whether the carer 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 carer needs an advocate and how to make a referral.

Managing Disengagement

If the carer does not engage in the review process taking place you should;

1. Establish whether the reason for their disengagement is related to substantial difficulty, and if so ensure they have the right support in place (an advocate or an appropriate other person);
2. Provide them with information to support them to understand the purpose of a review, the process and the benefits of being involved.

If the carer continues to disengage from the process you should;

1. Explain to them that a review is a legal requirement as part of the duty to meet their eligible needs;
2. Establish if there is anyone else that the carer wants to represent them in the process; and
3. Explain that you will proceed to complete a review based on the information that is available.

If the carer continues to disengage you should proceed to carry out a review based upon the information available. This should be done in consultation with anyone that the carer consent you to consult with.

A copy of the review must be provided to the carer and they should be invited to review it. If at any point the carer changes their mind about engaging consideration should be given to the benefit of carrying out a further proportionate review to ensure their involvement.

Refused access to a carer requiring a Review

Sometimes another person may obstruct you from carrying out a review with a carer who has Support needs. You should establish whether;

1. The carer with Support needs has asked the person to obstruct the process, and if so whether they understand the implications of doing so; or
2. The person obstructing the process is doing so out of concern for the carer with Support needs (for example would the process cause anxiety).

Wherever possible you should provide information and advice relating to the review process to the person obstructing it, to support them to understand the benefits and engage in the process.

If the person continues to obstruct the process, and you are not able to establish from the carer with Support needs that this is at their request you must take action to ensure the process is carried out. By obstructing the review process the person is;

1. Possibly putting the carer with Support needs at risk through lack of support;
2. Preventing the carer from being involved in reviewing and deciding how their Support needs are met; and
3. Possibly preventing the Local Authority from fulfilling its duties under the Care Act to meet eligible needs.

A review process in this situation can be carried out based on the information available and through consultation with anyone that the carer has previously consented to be involved in any Care and Support process (unless consent is known to have been withdrawn).

The advocacy duty should be considered and it is likely that a referral would be appropriate to ensure that the carer's involvement in the process is maximised.

Opportunities to carry out a further review must be considered at such time when the carer is involved, and all information sharing should give regard to confidentiality.

Click here to access the Information Sharing Policy.

Consideration should also be given to instigating an adult safeguarding concern if;

1. There are concerns that the person being cared for may be at risk of abuse or neglect; or
2. There are concerns that the carer is a vulnerable adult themselves and may be at risk of abuse or neglect (for example, by the person obstructing the review).

3. Gathering, Understanding and Using Available Information

What the Care Act says

The Care Act is clear that you should not ask the carer (or anybody that you consult with for the purpose of review) to repeat information that has already been made available to you unless there is a valid reason for doing so. For example, if you have not understood the information and want to clarify the meaning behind it then it may be appropriate to ask for it to be repeated, summarised or clarified.

Before continuing or beginning to carry out any kind of review you should take some time to read through the information that is already available for the purposes of;

1. Understanding it; and
2. Thinking about how it should inform the review process.

Sources of existing information

Existing sources of information may be available via;

1. Recordings of any contact made;
2. Letters, texts and e-mails;
3. A confidential conversation with a colleague or manager who is familiar with the carer;
4. Records relating to current or historical safeguarding enquiries or concerns;
5. Existing or historical mental capacity assessments; or
6. Existing or historical assessment reports, review reports or Support Plans.

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 Information Sharing Policy.

Other sources of information available

It may be appropriate and necessary for you to undertake an element of research in order to improve your own knowledge or awareness of a particular issue or health condition;

1. By speaking with a colleague who possesses skills and knowledge in a particular area;
2. By reading particular guidance or written resources about a particular medical condition;
3. By accessing a reputable website for information and advice (for example Parkinson's UK, the British Institute for Learning Disabilities or MIND).

Click here for details of some national organisations offering a specific information and advice helpline.

Click here for a wider range of useful national contacts for adult Care and Support.

Consultation with the Carer

You may need to speak to the carer in advance of arranging their review in order to gather or clarify any information.

Gathering Information and Consulting with Others

Under the Care Act you are only permitted to consult with those people that the carer has consented to you consulting with. If you are of the view that consultation would be beneficial you should seek the carers consent to consult. If this is not provided you may not consult.

4. Arranging the Review and Preparing the Carer

Legally you must have regard to the following when arranging a review;

1. The carer's views and wishes about when and how the review is carried out, including who they would like to support them;
2. The impact of any delay in review on their individual Wellbeing; and
3. Whether any information and advice can be given to them that will prevent, delay or reduce the need for Support.

When to arrange the 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.

In addition;

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.

The precise timing of the review should be agreed with the carer and anyone else that the carer has consented to be involved in it.

You should also take into account the following;

1. The level of risk to the carer and the person they care for;
2. The level of need being met by the plan;
3. Current support in place and the sustainability/effectiveness of this;
4. The urgency;
5. The likelihood of deterioration (for example is the carer at breaking point);
6. Any clear indication of timeframe provided within any recorded contact; and
7. Whether the carer will need the support of an independent advocate and the time it may take to arrange this.

How to arrange the review

The method of communication should reflect that requested by the carer and any specific communication needs they may have. For the purposes of the Care Act communication about the review 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.

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 it.

What should be considered when arranging the review

The most important thing you must consider when arranging the review is how you will ensure the involvement of the carer. Some of the things you should think about include;

1. Whether the carer will require independent advocacy;
2. Whether the carer will find any review process to be emotionally difficult and what can be done to reduce their anxiety;
3. The information the carer may need to prepare for the review;
4. Whether the carer would like for anyone in particular to be involved in any review;
5. Which environment would be best to meet in (if a meeting is to be arranged);
6. Whether the review needs to be arranged around any work commitments the carer has; and
7. Whether the review needs to consider any physical needs the carer has for medication or rest.

When arranging the review you should also identify other people who may need to be a part of it. For example, a health professional or a service provider may need to be involved. As long as the carer consents you should arrange for others to be involved if their involvement would be beneficial.

Preparing the Carer for Review

Under the Care Act you must provide information about the review to the carer as early as possible. This will help ensure their involvement in the review and any subsequent Care and Support processes. Wherever practical this should be provided before the review process begins.

Any information should be provided in an accessible way for the carer who will be receiving it. In all cases where information has been provided by telephone a follow up letter confirming the information provided should be sent to the carer.

The information that should be provided is as follows;

1. Information about what can be expected during the review process;
2. The purpose of the review process;
3. The format that the review will take (e.g. telephone review, face-to-face review);
4. The indicative timeframe for review (when will it begin and how long is it likely to take);
5. The complaints process; and
6. Information about possible access to independent advocacy.

You should also provide a list of any questions that you intend to ask of the carer during the review (which will be different depending on whether the review is 'light touch' or not).

Information about finances

You must inform the carer that a financial assessment may need to take place following the review if;

1. The review identifies that there has been a change in the carer's financial circumstance; or
2. There is a change to the Support services provided by the Local Authority.

You should explain that the outcome of this will determine whether they will need to make a financial contribution to the cost of any support arranged for them.

Financial assessment is often a key point of anxiety for people and it is important that you are able to provide good information and advice (either directly or by supporting the carer to access it from an appropriate person or source).

It is your responsibility to understand the local charging policy around carer's and to provide this information to the carer, particularly whether or not a financial assessment or reassessment may need to take place should the review identify a change in their circumstances or needs.

For further detail about specific information about financial assessment that must be given under the Care Act click here.

Click here to see the answers to some frequently asked questions around financial assessment.

5. Using Independent Advocacy

If the need for independent advocacy has not already been established then this should become clear when either arranging the review or providing information about it. As soon as this is established you must consider whether the duty to make independent advocacy applies and, if so make the necessary arrangements.

6. Preparing Others for Involvement

In all cases

In some cases the only person who will need to be involved in any review will be the carer with Support needs. In other cases more people will need to be involved because;

1. The carer has asked you to involve another person (for example, the cared for person);
2. The carer has consented to the involvement of another person; or
3. The carer will be using independent advocacy.

It is important that everyone who is to be involved in a review is aware of;

1. The purpose of the review;
2. The process of review; and
3. Their role in any review.

The needs of others involved in a review should also be considered, but this should not be at the detriment of maximising the carer's own involvement.

If a person has a role in the review process but is not able to physically attend any planned meeting it is possible under the Care Act to consult with them separately and still include their views in any review and decision making processes.

Preparing family members

The Care Act is clear that a whole family approach to review should be taken wherever possible. This means that you should;

1. Establish who relevant family members are; and
2. Arrange for them to be involved in the review if the carer consents to this.

Relevant family members include the cared for person, anyone living with the carer, including older adults and any children. It can also include family members who are not living with the carer, but who are still involved or interested in the carer's wellbeing.

7. Deciding the Method of Review

The different methods of review available

The Care Act recognises a whole host of different methods of review, any of which could be appropriate so long as;

1. The carer's involvement is maximised by the method;
2. The method is proportionate to the needs being met by the Support Plan; and
3. The method enables the review to be carried out as quickly as is reasonably practical.

Possible review methods include;

1. Face to face review;
2. Telephone review;
3. Online review;
4. Combined review (with the cared for person);
5. Joint or integrated review;
6. Supported self review; and
7. Delegated review

Combining a Support Plan review with a Care and Support Plan review

You should consider carrying out a review of the carers Support Plan at the same time as any Care and Support Plan review of the cared for person (or arranging for a Care and Support Plan review to be carried out at the same time if carrying out a Care and Support Plan review is not your role).

A review of a Support Plan can be carried out under the Care Act as a combined review at the same time as any review of a Care and Support Plan, so long as;

1. It is deemed appropriate to do so (for example both parties involvement can still be maximised and there is no conflict between the parties);
2. Both the person and the carer agree to a combined review process; or
3. The person with Care and Support needs lacks capacity to agree but a best interest decision is made to carry out a combined review; and
4. Both parties consent to sharing information with each other for the purpose of combined review; or
5. The person with Care and Support needs lacks capacity to consent but a best interest decision is made to that effect.

Combining a review with a Direct Payment review

Whenever a carer is receiving a regular Direct Payment you should consider carrying out a Direct Payment review (or arranging for a Direct Payment review to be carried out at the same time if carrying out a Direct Payment review is not your role).

Click here to access the procedure for carrying out a Direct Payment review.

Delegating a review

Under the Care Act it is possible to delegate the review function to another organisation or individual, although the Local Authority remains legally responsible for the entire process, including;

1. Ensuring the review is carried out as per statutory requirements and timescales agreed in the Support Plan;
2. Overall co-ordination of the review process;
3. Agreeing the outcome of the review and any next steps; and
4. Agreeing any changes to the Support Plan that may arise from the review process.

Occasions when you may decide to delegate a review include;

1. If the carer lives in another area of the country and the Local Authority in that area agrees to carry out the review;
2. If the carer asks to carry out their own review and this is deemed appropriate;
3. If the review is a combined review and another practitioner/organisation agrees to carry out the whole review.

It is important that any person who is carrying out a review on behalf of the Local Authority is suitably skilled, knowledgeable and competent to;

1. Carry out the review; and
2. Work with the particular needs and circumstances of the carer.

Depending on the carer's needs and circumstances the following could all carry out a delegated review if deemed appropriate;

1. The carer (with or without support);
2. A health professional;
3. A service provider;
4. Another social care practitioner, including a practitioner from another Local Authority area.

When deciding whether to delegate a review you should consider;

1. The views of the carer about delegating the review;
2. The skills, knowledge and competence of the person the review is to be delegated to (and whether there is any information or advice that can be provided to them);
3. The likely outcome of the review;
4. The complexity of need or number of issues at the point of review.

If a review is to be delegated you must make sure that you provide sufficient information to enable the person carrying out the review to do so adequately. This includes information about the carer's Support Plan, needs and the review process itself.

How to decide the method of review

When making a decision about the method of review you must have regard to;

1. The wishes and preferences of the carer;
2. The outcome the carer seeks from the review; and
3. The frequency and intensity of support the carer provides.

Some of the other factors that should be considered include;

1. Availability of a particular review method;
2. Whether carrying out a combined review process would be beneficial;
3. Whether the method of review chosen poses any challenges or risks for the carer;
4. The specific communication needs of the carer(specifically whether they will be able to engage in the review method);
5. The potential fluctuation of the carers needs or situation; and
6. Any need for multidisciplinary working or review.

8. When the Carer has a Direct Payment

Whenever a carer is receiving a regular Direct Payment you should consider carrying out a Direct Payment review (or arranging for a Direct Payment review to be carried out at the same time if carrying out a Direct Payment review is not your role).

Click here to access the procedure for carrying out a Direct Payment review.

9. Tools to Support Review

Using a tool to support the process of review can be useful for all involved. If you are going to use a tool you should endeavour to provide this to the carer (or whoever will be supporting them) before the review is scheduled to take place.

10. Joint Review

Sometimes there may be a clear benefit to carry out a joint review with another service area, team or professional. The Care Act recognises this and permits the Local Authority to make any arrangements it deems appropriate in order to facilitate joint working with others.

Where a service is commissioned jointly there is an expectation that any review is carried out jointly to prevent unnecessary duplication.

The duty to co-operate

Where the Local Authority requests another party work jointly in some way to benefit the carer with Support needs that party has a duty to co-operate with the request (unless by doing so they will be prevented from carrying out their own duties under the Care Act or other legislation).

For further information about the duty to co-operate under the Care Act click here.

How to request a joint review

Any decision to request a joint review should be made with the carer.

Joint review requests should be made in the manner preferred by the service or team to which the request is being made. This may or may not take the form of a referral.

The request should explain clearly the nature of the joint work required and any specific skills, knowledge and competence requirements of the practitioner to support allocation.

Each service area/team within adult Care and Support has an area of these procedures and information about how to access specific services can be found there.

Any available referral forms for health and housing services can be accessed by clicking here.

Responding to a request for a joint review

If you have been asked to carry out a joint review with a colleague in adult Care and Support or in another organisation (such as health or housing) you should contact the person you will be working jointly with to confirm your involvement and discuss the most effective way to work together. The things you should establish include;

1. Whether they have any information that you need to know or can use to avoid duplication;
2. Whether there are opportunities to co-ordinate systems and processes and, if so how this will be managed;
3. What the expectations are in terms of joint-working (for example who will be responsible for arranging the review and recording the record);
4. What the anticipated outcome of the joint review is (for example joint funding of support, on-going joint-work to monitor);
5. What does the carer with Support needs know about the joint review to be carried out (and if they don't know who and how should this be explained);
6. Who will be the primary contact for the carer (or their representative) to go to with any queries; and
7. Who will be responsible for communicating progress and decisions to the carer.

Further practice guidance about effective joint working can be found in the joint-work procedure by clicking here.

11. Preparing in an Urgent Situation

Sometimes the timeframe within which to arrange a review is not conducive to all of the considered planning and preparation as outlined in this procedure. For example, there may always not be the time to research and make the best use of available information or to consult with others before arranging to meet with the carer. However, even when the timeframe is short it is of paramount importance that you still;

1. Take all available steps to ensure the involvement of the carer in any review;
2. Consider consent and substantial difficulty;
3. Provide independent advocacy where there is a statutory duty to do so;
4. Prepare the carer as much as possible;
5. Identify what existing information is important and understand it; and
6. Know what you have not been able to do and ensure that at the earliest opportunity you make arrangements to do so (for example to consult with another professional or read a particular report).