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 via our care and support hub (including the Personal Assistant Finder) click here;
2. To access information over the telephone call 0208 227 2915;
3. To access information in person visit the
   Heathlands Day Centre,
   520 Heathway,
   Dagenham
   RM10 7SE;
4. Click here to see the answers to some frequently asked questions around financial assessment, including questions relating to Disabled Facilities Grants.

The following local organisations are also able to provide general information and advice relating to all aspects of adult Care and Support (including finances):

1. Citizens Advice Bureau Dagenham
   339 Heathway,
   Dagenham
   RM9 5AF
   Telephone: 0208 507 5969
   Website: www.bdcab.org.uk/;
2. Citizens Advice Bureau Barking
   Barking Learning Centre,
   2 Town Square,
   Barking
   IG11 7NB
   Telephone: 0208 507 5969
   Website: www.bdcab.org.uk/;
3. Independent Living Agency
   123 Rainham Road North,
   Dagenham
   RM10 7FD
   Telephone: 0208 593 6677
   E-mail: independentlivingagency@btconnect.com
   Online contact form: www.independentlivingagency.org/contact-us
   Website: www.independentlivingagency.org/.

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.

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 the service 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 service follows up on it at the agreed time.

3. Authorisation of Equipment for Hospital Discharge

If the referral is being made to facilitate a hospital discharge local processes should be followed to;

1. Review the information provided by the hospital team;
2. Authorise any equipment requested;
3. Make arrangements for the equipment to be provided; and
4. Carry out any further assessment post discharge as required.

Click here to access any available processes.

4. 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.

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. Sometimes it may become clear that another prevention service will be beneficial to the person;

1. Instead of Occupational Therapy; or
2. In addition to an Occupational Therapy service.

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

Click here to access the Care Technology procedures.

Click here to find out about accessing the Occupational Therapy service.

Click here to access the procedures for Minor Works and low level equipment.

5. Minor Works and Low Level Equipment

Sometimes the information gathered at contact, referral or through consultation with others will evidence that the most appropriate and proportionate response is to provide minor works or low level equipment.

When arranging minor works and low level equipment you must ensure that appropriate mechanisms are in place to;

1. Support the person (and any carer) to use the equipment provided safely;
2. Monitor the effectiveness of the works and equipment; and
3. Review the need for further assessment or intervention.

You should refer to available local guidance to confirm which works and equipment can be provided through the minor works scheme.

6. 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.

7. Transferring a Contact

It is important that the person making contact speaks to the right practitioner at the right time. Sometimes you may find that you are not the most appropriate practitioner to manage the contact.

Transferring a telephone contact

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.

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 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;
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; and
4. Agree with the person what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

Click here to see the process for sending electronic messages.

Transferring a written, e-mail or text contact

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.

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 e-mail, 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.

Click here to see the process for sending electronic messages.

Any original copies of e-mails must be sent via internal secure e-mail systems only and any original letters must be sent via internal postal services or secure delivery only.

Click here to access the Information Sharing Policy.

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. Leave the practitioner a message alerting them to the contact, where it can be found on the recording system and any action undertaken, including what has been agreed with the person if contact has been made with them;
2. 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 and writing any acknowledgement letter to confirm arrival of the contact;
3. When the practitioner is not available within any timeframes indicted in the written contact or for more than a few days inform the person making the contact of this;
4. Agree with the person what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

8. Safeguarding Concern

Where the information gathered requires further action under safeguarding;

1. Click here to access the adult safeguarding procedures, including how to recognise abuse and neglect, how to raise a concern, how to record safeguarding information;
2. Click here to access the Local Safeguarding Adults Board Multi-Agency Safeguarding Procedures; or
3. Click here to access the Local Safeguarding Children's Board Multi-Agency Procedures.

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 and seek immediate medical support if necessary.

9. 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, with 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. The Care and Support process requiring advocacy support cannot begin until it is in place.

Click here to access any available advocacy referral forms.

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.

10. Maintaining Existing Equipment

If a request is made for existing equipment to be maintained because it is not operating as it should be you must establish whether the warranty for the equipment is the responsibility of the Local Authority, a private manufacturer or the person.

This is likely to depend on a range of factors, such as;

1. How long ago the equipment was installed;
2. The details of any manufacturer's warranty; and
3. Whether the equipment is part of standard stock held in equipment stores.

You should familiarise yourself with available local guidance that confirms who is responsible for maintaining or repairing equipment in a range of circumstances.

11. 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.

12. Assessment without Allocation

It is not possible to provide any equipment or adaptations without allocation for a formal assessment of the person's needs in their environment unless;

1. Adequate information has been gathered at contact, referral or through consultation; and
2. A decision has been made to provide minor works or low level equipment only; and
3. Arrangements are in place to appropriately monitor the safe use and effectiveness of the minor works and equipment provided.

All other equipment/adaptations cannot be safely provided without a full assessment to determine;

1. That the right equipment to meet the need is being provided; and
2. That the person and/or their carer are able to use the equipment safely; or
3. That the current home environment is not meeting the person's needs (or poses significant risk to the person); and
4. An adaptation to the home environment is required.

13. Allocation for Assessment or Support

When to allocate

Where the outcome decision is for the person's case to be allocated to an individual worker to carry out an assessment (or other intervention) this allocation 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.

An element of monitoring should be incorporated into any allocation process to ensure that you 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 you 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 you must take steps to ensure that these are met.

If a practitioner from a social work service is already involved with the person you 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.

Sometimes you may be asked to arrange urgent or interim Care and Support on behalf of the social work practitioner or team. You should discuss any such requests with your line manager. You should arrange to arrange the support when the request is;

1. Deemed appropriate; and
2. You have the capacity to arrange the urgent support; and
3. You possess the skills and knowledge required to arrange the urgent support.

If the person is not known to a social work service you will need to decide whether to;

1. Proceed to arrange the urgent support yourself (if you have the capacity and knowledge to do so); or
2. Make an urgent referral/request to a social work service.

You can find out how to access social work services by using the How to Access the Service procedures in each service/team area within this site.

If you will be arranging urgent or interim support yourself click here to access the general procedure, including when to arrange urgent support and how to seek funding agreement for urgent support.

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.

14. Transferring a Case Internally

Sometimes the information gathered at contact, referral or through consultation evidences that a different service in the Local Authority may be better placed to assess and support the person.

If this is the case you should make an internal referral to the Assessment Team, and include the following information if this is not already clearly recorded.

When making an internal referral please ensure that the following information is included;

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), for example whether the referral is being made as part of a safeguarding action plan or response.

If any of the above information is missing allocation may not be possible, and further information may be required.

15. Joint Work

Joint work and Occupational Therapy

Occupational Therapy is often an integral part of many other adult Care and Support interventions. As such many referrals will require an element of joint working, for example when made by;

1. A social work service carrying out a needs assessment;
2. A health professional (for example, a community nurse); or
3. A service provider (for example a domiciliary care provider or a day service).

The Care Act encourages joint working within organisations and across organisations, permitting anyone carrying out a Care and Support process to make any arrangements it deems necessary in order to facilitate joint working.

The duty to co-operate

Where the Local Authority requests another party work jointly in some way to benefit the person with Care and 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.

Responding to a request for joint work

If the service has been asked to work jointly with a colleague in adult Care and Support or in another organisation (such as health or housing) you should contact the person/service you will be working jointly with to;

1. Confirm the outcome of the referral; and
2. Provide a proposed timeframe for allocation (where allocation is appropriate).

If there are likely to be delays in allocation and commencement of joint work the person who requested the joint work will need to;

1. Consider whether to proceed with their intervention; or
2. Await allocation of an Occupational Therapy practitioner.

It is the responsibility of the person requesting joint work to make this decision (in agreement with the person and any carer) and to take steps to ensure that any urgent needs for Care and Support are met.

When you have been allocated and asked to work jointly with another service or professional you should contact them to confirm your involvement and discuss the most effective way to work together. The things you should establish include;

1. The work they are doing/will be doing/have done and 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 will you be expected to carry out a joint assessment, meet with the person together, produce joint records or just consult and share information);
4. What information will be shared and how (this should be in line with local information sharing policies);
5. What the anticipated outcome of the joint work is (for example joint funding of support, on-going joint-work to monitor);
6. What does the person with care and support needs know about the joint-work to be carried out (and if they don't know who and how should this be explained);
7. Who will be the primary contact for the person (or their representative) to go to with any queries; and
8. Who will be responsible for communicating progress and decisions to the person.

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

How to request joint work or assessment

Any decision to request joint work should be made with the person (or their representative). Where the person is unable to provide consent to joint work decisions should be made in their best interests.

Joint work 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.

Carrying out joint work or assessment