Signing Off a Care and Support Plan and Agreeing a Final Personal Budget

1. Using this Procedure

These procedures should be used to agree a final personal budget and sign off Care and Support Plan relating to a person with Care and Support needs.

Anyone working with a carer should see: Signing Off a Support Plan and Agreeing a Final Personal Budget (Carers).

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

1. Sensory Team;
2. Community and Hospital Assessment Team;
3. Locality Teams;
4. Enablement and Assessment Team; and
5. Long Term & Move on Review and Support Teams.

2. Submitting a Draft Plan for Sign Off

Making sure the draft plan meets the requirements for sign-off

You are responsible for establishing the current assessment 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 assessment.

The following information must be recorded on the draft plan before it can be signed off;

1. The person was as involved in the plan as they want to be;
2. All the needs identified by the assessment;
3. Which of these needs are eligible using the national eligibility criteria;
4. Which needs the Local Authority is going to meet and how it is going to meet them;
5. How any risk to the plan will be managed;
6. Which needs are going to be met informally, or through alternative services;
7. The information and advice that has been given about reducing, delaying or preventing needs that the Local Authority is not going to meet;
8. How you propose the plan will be reviewed or monitored;
9. The method of managing the personal budget proposed;
10. Where a Direct Payment is proposed, which needs are to be met with the Direct Payment;
11. Where a Direct Payment is proposed, any associated employer related costs;
12. The indicative personal budget; and
13. The proposed final personal budget.

Recording respite and other services to support a carer

When services to support a carer are being provided directly to the person with Care and Support needs (for example respite services) it is important that the services are recorded appropriately to ensure that the carer is not charged for the services;

1. The description of the service being provided should be recorded on both the Care and Support Plan and the carer's Support Plan (as part of the contingency plan); but
2. The cost of the service should only be recorded on the Care and Support Plan (as the service is not being provided to the carer as part of their personal budget).

When the proposed personal budget is greater than the indicative budget

If the personal budget being proposed in the plan is greater than the indicative budget generated by the person's needs following assessment additional information will need to be provided when submitting the plan for sign-off (see below).

When the cost of the plan is more than the proposed personal budget

Sometimes the cost of the total plan will exceed the amount of the personal budget being requested. This is because the Care and Support Plan may detail all of the ways that a person's needs are to be met, not just those methods being provided by the Local Authority. For example;

1. The person could be accessing a chargeable service in the plan that they will fund themselves through another means;
2. The person's family could be paying for a social activity in the plan that meets needs; or
3. The local ICB have agreed to contribute some of the cost of the plan because of the person's level of health needs (known as joint funding).

Where there is a difference between the total cost of the plan and the personal budget, the amount that anyone else is going to pay should be clearly recorded on the plan.

Delegated draft plans

When the Care and Support Planning process was delegated to the person, their representative or another organisation you are still responsible for ensuring that the draft plan submitted meets the requirements for sign-off.

The process of submitting the draft plan

When the plan is prepared you should submit it for sign-off as per local processes. If you are not familiar with the process seek advice from your line manager.

3. Additional Information to Provide when the Proposed Personal Budget is Greater than the Indicative Budget

When the cost of the plan is greater than the amount of the indicative budget you need to ensure that additional information is provided in a proportionate and appropriate way to support the person signing off the plan to reach an informed decision about the need to increase the indicative budget amount.

In particular you will need to demonstrate;

1. That a strengths based approach to meeting needs has been taken;
2. The range of options that have been explored to meet needs (particularly that these have been appropriate and proportionate to the level of need);
3. The rationale for decisions when exploring the best way to meet needs (including why alternative options were not deemed appropriate, how outcomes and Wellbeing have been regarded and that there has been a positive approach to risk taking); and
4. The options to reduce, prevent or delay needs that have been explored.

4. Signing Off the Plan and Agreeing the Personal Budget

Transparency, timeliness and Sufficiency

These are the 3 principles in the Care Act that apply to any process that will decide a personal budget.

Click here to read more about these principles and the Care Act requirements when signing off a Care and Support Plan.

You must make sure that the process you use to sign off Care and Support plans and agree final personal budgets is robust and consistent. The process should not allow for a variance in how budgets are decided or situations where people with similar needs receive different outcomes from the process.

Click here to access a tri.x tool that can support consistent decision making when signing off plans and agreeing final personal budgets.

In all cases

The final plan must;

1. Be appropriate and proportionate to meet the eligible needs of the person;
2. Contain clear outcomes for review purposes; and
3. Represent the best use of available resources (both local services and Local Authority financial resources).

When considering each of the above you must have regard for the person's Wellbeing and outcomes at all times and be able to demonstrate that you have taken into account their reasonable preferences about how to meet needs when signing off the plan and agreeing the final personal budget.

You should consider all of the evidence and information provided by the social care practitioner during the sign off process. If you require further information from the social care practitioner you should request it before signing off the plan.

Helpful questions to ask during the sign off process include;

1. Has the person been involved in the plan (is there evidence that they have been supported by an appropriate person or representative)?
2. Will the plan promote individual Wellbeing?
3. Is it clear from the plan what the person's outcomes are (and are they realistic)?
4. Is it clear how the plan will support the person to achieve their outcomes (including how any care and support services will contribute to this)?
5. Will the plan promote the person's independence, choice and control over how their needs are met and outcomes achieved?
6. Does the plan maximise opportunities to prevent, reduce or delay needs?
7. Does the plan demonstrate that a strengths approach to meeting needs has been used (rather than a traditional service led approach)?
8. Do the services/support options explored make best use of available resources (both local services and Local Authority financial resources)?
9. Is the level/intensity of service/support in the plan proportionate to meet the person's needs and manage risk?
10. Is the type of service/support in the plan appropriate and proportionate to meet the person's needs (for example, if the service/support is specialist is this level of specialism required)? and
11. Is any contingency plan proportionate to the level of need and risk?

Direct Payments

When the method of managing the personal budget (or part of the budget) is to be a Direct Payment there are additional considerations that you must make before signing off the plan. These considerations are in relation to;

1. The appropriateness of a Direct Payment based on the person's needs and circumstances; and
2. Whether the cost of meeting needs through a Direct Payment represents the most effective use of Local Authority resources.

The appropriateness of a Direct Payment

Before signing off the plan you must be satisfied;

1. That the person who will be receiving the Direct Payment is able to manage it;
2. That the Direct Payment is not going to be used to pay for Care and Support provided by a relative living in the same household as the person (unless there has been prior agreement due to the specific circumstances of the person);
3. That the Direct Payment is not going to be used to meet needs in a care home for more than 4 weeks a year; and
4. From the information available to you that the person with care and support needs is not subject to a requirement, license or order that requires them to undertake drug or alcohol rehabilitation, behaviour therapy or testing.

If you have any concerns about the appropriateness of a Direct Payment you should discuss this with the social care practitioner before signing off the plan. Unless it is clear that the criteria for a Direct Payment has not been met then you should still agree the Direct Payment, but it may be necessary to impose some conditions on the provision and use of a Direct Payment, such as;

1. Prohibiting a named person from providing care;
2. Increasing the frequency of Direct Payment reviews; or
3. Requiring certain information is provided at specific times to ensure effective monitoring of the Direct Payment.

Click here to access the full procedures for Direct Payments.

The cost of a Direct Payment

If the plan proposes a Direct Payment being used to employ one or more personal assistants to meet eligible needs you must take into account any additional costs associated with fulfilling the associated legal requirements of being an employer in any final personal budget amount. These should be clearly recorded on the draft Care and Support Plan.

If the plan does not propose using the Direct Payment to employ a personal assistant, but instead to commission more traditional services you should be satisfied that the person contracting directly with the service through a Direct Payment represents the best use of the financial resources available to the Local Authority. In making a decision about this you must consider;

1. Whether the service could be commissioned directly by the Local Authority at a higher or lower cost than through a Direct Payment;
2. Whether the service would be able to provide the level of flexibility required if commissioned by the Local Authority; and
3. What the implications would be for the person's Wellbeing or outcomes if the Local Authority commissioned the service directly.

If the service proposed is a service that the Local Authority could commission in the same way but at a lower cost, you should discuss whether a Direct Payment is still the most appropriate method of managing that element of the personal budget with the social care practitioner before signing off the plan.

The Local Authority is not required to set the amount of the personal budget higher where the cost of an alternative provider arranged via a direct payment is more than the cost to the Local Authority of arranging the same support whilst achieving the same outcomes for the person.

Signing off the plan and deciding the final personal budget

If the plan is appropriate, proportionate and makes effective use of available resources you should proceed to sign the plan off, determine the final personal budget and notify the social care practitioner of the outcome.

Regardless of whether the cost of the draft plan is less than, equal to or greater than the indicative budget the cost of the draft plan must be agreed as the final personal budget when;

1. You have taken into account the reasonable preferences of the person about how to meet needs;
2. The plan has been deemed appropriate and proportionate to meet needs;
3. The plan has been deemed to make the best use of available resources; and
4. Where a Direct Payment is used you are satisfied that this is appropriate and cost effective.

If you are not already familiar with the process for signing off a Care and Support Plan seek advice from your line manager.

When the plan is signed off and the final personal budget amount agreed the draft Care and Support Plan must be updated to ensure that it contains all of the required information relating to the personal budget;

1. The cost to the Local Authority of meeting the needs as set out in the plan;
2. The amount which, on the basis of the financial assessment, the person must pay towards the cost; and
3. The amount which the Local Authority is going to contribute towards the cost.

When the plan cannot be signed off

If you have used available evidence and requested any additional information from the social care practitioner but find the plan is;

1. Not appropriate or proportionate; or
2. Does not make effective use of available resources you should not sign it off.

Instead it should be returned to the social care practitioner who submitted it.

When returning a plan you must;

1. Be clear about the reasons that the plan has not been signed off at that time;
2. Suggest steps that the practitioner may take to resolve the issues identified by the sign off process.

When the social care practitioner re-submits the plan it should be considered again.

5. Action when a Care and Support Plan is Signed Off

Finalising the plan

When the plan is signed off and the final personal budget amount agreed the Care and Support Plan must be updated to ensure that it contains all of the required information relating to the personal budget;

1. The cost to the Local Authority of meeting the needs in the plan;
2. The amount which, on the basis of the financial assessment, the person must pay towards the cost; and
3. The amount which the Local Authority is going to contribute towards the cost.

Sometimes the cost of the total plan will exceed the amount of the personal budget. For example;

1. The person will be residing in residential care that costs more than the personal budget amount with the difference being met through a third party top-up arrangement;
2. The person will be accessing a service in the plan that they will fund themselves through another means;
3. The person's family will be paying for a social activity in the plan that meets needs; or
4. The local ICB have agreed to contribute some of the cost of the plan because of the person's level of health needs (known as joint funding).

Where there is a difference between the total cost of the plan and the personal budget, the amount that anyone else is going to pay should be clearly recorded on the plan.

Providing a copy of the plan to the person

You should contact the person whose plan it is (or their representative) to let them know that it has been signed off as soon as possible after being notified.

Following the sign off process the person must be given a written record of the Care and Support Plan.

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

It is important that the person understands;

1. The Care and Support Plan; and
2. How their personal budget has been decided.

If you are of the view that the person will experience substantial difficulty understanding the plan then you must make sure that appropriate support is in place, including consideration of the duty to provide an independent advocate.

If an independent advocate is already in place they should be informed when the plan has been provided so they can support the person to understand it.

Providing a copy to others

Where the planning process was carried out jointly with another organisation to avoid duplication (for example housing or health) a copy of the plan must be made available to the other person that carried it out with you.

A copy should normally be shared in full with any carer unless the person has capacity and has asked you not to share the plan, or to share only part of the plan. In this case you will need to discuss and agree which elements of the plan are to be shared having regard for confidentiality.

In all other cases a copy of the Care and Support Plan can only be shared with the person's consent (or in their best interests if they lack capacity to consent).

If the person consents (or lacks capacity and a best interest decision is made) a copy of the plan should be shared with any service provider who will be responsible for providing Care and Support to the person.

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

Concerns about a request

Sometimes the person will request a copy of the plan is provided to a person who was not involved in the process. You must provide a copy of the plan to anyone that the person requests you to unless;

1. They lack capacity and you make a decision that sharing would not be in their best interests; or
2. You are concerned that doing so could put the person (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 the person at risk; or
3. To decline to provide a copy of the record (although the person can of course still choose to make a copy available from their own record).

Amending a Care and Support Plan

Sometimes the person (or their representative if they lack capacity) may ask for amendments to be made to the Care and Support Plan. You should;

1. Consider the request;
2. If the person whose Care and Support Plan it is has not made the request, consult with them (or their representative if they lack capacity); and
3. Review any evidence or information you have which may support or refute the request.

If you reach an agreement with the person about the need to amend the plan you should either do so.

The amended plan will need to be signed off but this should be done in a proportionate way to reflect the level of the changes made to the plan. This may or may not involve a full sign off process.

The amended plan should be circulated to the same people as the original plan, unless the person requests otherwise.

If you are unable to reach an agreement with the person and you feel that an amendment is not required you should not make the amendment. You should be clear about your reasons for not making the amendment and you must make the person aware of their right to complain about your decision.

6. Action when a Care and Support Plan is not Signed Off

Understanding why the plan has not been signed off

The draft plan will not have been signed off for one of 2 reasons;

1. It is not appropriate or proportionate; or
2. It does not make effective use of available resources.

The person who has returned the plan to you should have explained the reasons that the plan has not been signed off.

They should have also suggested the steps that you need to take to resolve the issues with the plan before resubmitting it for sign off.

If it is not clear to you what the issue with the plan is then you should;

1. Discuss this with your line manager; or
2. Discuss this with the person who did not sign it off.

Resolving the issues with the plan

When you understand why the plan has not been signed off you should think about the steps that you now need to take.

A request for information

Where a plan has not been signed off because you did not provide sufficient information or evidence to enable a decision to be made, you should consider whether this information is available. If it is available you should provide it and resubmit the plan for sign off.

If the information is not available you should consider how it can be gathered.

A need to revise the plan

Where a plan has not been signed off because there is a particular element that has raised a query you should;

1. Establish whether you have information or evidence that can be submitted to resolve the query;
2. Make arrangements to undertake (or revisit) steps of the Care and Support Planning process as required.

When you have taken the necessary steps and made any amendments to the draft plan it should be resubmitted.

Notifying the person

You should notify the person (or their representative) that the plan has not been signed off and the reasons for this at the earliest opportunity.

Where you have been able to provide additional information and resubmit the plan you should confirm to the person the new timeframe for sign off.

Where you are required to undertake (or revisit) steps of the Care and Support Planning process you should agree how best to do so with the person.

The right to complain

If the person (or their representative) is unhappy with the decision not to sign off the plan you must make them aware of their right to complain about the decision.

Urgent and Interim Support

If the need to meet needs is urgent you may need to arrange interim services to ensure that urgent needs are met during the Care and Support planning sign off process. If this is the case you can access the procedures for arranging urgent or interim support and services by clicking here.