Deciding the Outcome of a Contact or Referral (Carers)

1. Using this Procedure

This procedure should be used to decide the outcome of a contact or referral regarding a carer with Support needs.

If the contact or referral relates to a person with Care and Support needs you should use the relevant procedure for your team/service.

2. Possible Outcomes

Taken from the Care Act statutory guidance, the following are just some of the possible outcomes of any type of contact or referral.

1. Recording of information only;
2. The provision of Information and Advice;
3. The provision of a preventative service (or supporting access to a prevention service provided by a partner organisation such as health);
4. Professional support without assessment;
5. Allocation for an adult carers assessment;
6. Transfer of the referral to another team/service in the Local Authority for a carers assessment;
7. Joint assessment with another team/service in the Local Authority;
8. Joint assessment with another Local Authority or organisation (for example, health);
9. The review or revision of an existing Support Plan; or
10. A combination of the above.

The outcome should not be prescribed or predetermined by factors such as the financial resources the carer or the Local Authority has available. It should be fair and should represent the most appropriate and proportionate way to meet the needs of the carer at that time. Additionally, there should not be variance between outcome decisions made about carers who have similar needs in similar circumstances.

tri.x has developed a tool that can be used as required to support decision making following a contact or referral.

See: Contact or Referral Tool.

Case Examples

3. What must be Considered

Legal Requirements that apply in all cases

The Care Act places certain duties on the Local Authority whenever it is making any decision about a carer with Support needs. These are things that you absolutely must consider and are:

1. The impact on the carer's individual wellbeing;
2. Whether information or advice can be provided to support the carer to find their own solution, or to delay, reduce or prevent the need for Support;
3. Whether any prevention service can be provided that will delay, reduce or prevent the need for Support.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Promoting Individual Wellbeing for information about the duty to promote individual wellbeing;
• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

When the referral is for an adult carer's assessment

When you are making a decision about the appropriateness of a request for an adult carers assessment you must answer the following questions:

1. Is the carer aged 18 or above?
2. Is the person with Care and Support needs aged 18 or above?
3. Does the carer have an appearance of need (either now or in the future)?

If you answer 'Yes' to all the questions then an adult carers assessment is appropriate and the carer is entitled to an assessment.

If the carer is under the age of 18 an adult carer's assessment is not appropriate and consideration should instead be given to carrying out a young carer's assessment (transition) or making a referral for a young carer's assessment under relevant children's legislation.

If the carer is over 18 but the person being cared for is under 18 an adult carer's assessment is not appropriate and consideration should instead be given to carrying out a child's carer's assessment (transition) or making a referral for a carer's assessment under relevant children's legislation.

If the carer does not have an appearance of need (either now or in the future) there is no duty under the Care Act to assess. However, you should still consider whether carrying out a carer's assessment will still be of benefit to them in terms of the prevention, reduction or delay of any future need for Support.

You must be satisfied that the carer is happy with any outcome provided to them that is not a formal assessment if they:

1. Requested a formal assessment of need; and
2. Have an appearance of need (either now or in the future).

If the carer is not happy and continues to request a formal assessment of need then the Local Authority has a duty under the Care Act to carry out such an assessment unless there is no appearance of need (either now or in the future).

When the contact is for a Review or Revision of an Existing Support Plan

Under the Care Act, when a carer is already receiving Support from the Local Authority they may request a review of their Support Plan at any time and the Local Authority must consider the request. Where the request is deemed reasonable the Local Authority has a duty to review the plan.

See: Responding to a Review Request.

4. A Strengths Based Approach

Wherever possible, every conversation with a carer should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the carer to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the carer and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Authority intervenes with an assessment or other support, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

1. Taking a holistic view of the carers needs in the context of their wider support network;
2. Helping the carer to understand their strengths and capabilities within the context of their situation;
3. Helping the carer to understand and explore the support available to them in the community;
4. Helping the carer to understand and explore the support available to them through other networks or services (e.g. health);
5. Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. See: Care Act guidance on Strengths-based approaches. Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

5. Ordinary Residence

What the Care Act says

A carer is deemed to be ordinary resident in the area where the person they provide care to lives, even if this is not the area where they themselves reside. As such it is the ordinary residence of the person with Care and Support needs that must be established in order to determine where the carer is deemed to be ordinary resident.

See what the Care Act says about Ordinary Residence, including understanding what ordinary residence is, how/when to establish ordinary residence and how/when to meet the needs of carers who are not ordinarily resident in the area.

To summarise, a carer's eligibility for an assessment is not determined in any way by ordinary residence and is based solely on the appearance of need (either now or in the future). Ordinary Residence must however be established before any eligible needs are met as the Local Authority only has a duty to meet the eligible needs of a carer that is ordinarily resident in its area.

In practice, most Local Authorities will try to establish ordinary residence before carrying out an assessment, so that the assessment is carried out by the Local Authority that will subsequently be responsible for meeting eligible needs. However, an assessment cannot be declined on the basis that a carer is not ordinarily resident in the Local Authority area.

How to proceed when it is clear from referral that the carer is not ordinarily resident

If a carer is not ordinarily resident, an assessment by the Local Authority that will not be responsible for meeting their eligible needs may not be in their interests or give them the outcome they are looking for. Information and advice should be provided to support the carer to understand ordinary residency and the benefits of having their needs assessed by the Local Authority in which they are ordinarily resident:

1. That the Local Authority in which they are ordinarily resident will have a duty to meet their eligible needs (as opposed to no duty to do so in this authority);
2. That the Local Authority in which they are ordinarily resident will have a duty to carry out Support planning with the carer to determine the best way to meet eligible needs (as opposed to no duty to do so in this authority); and
3. That the Local Authority in which they are ordinarily resident will have a duty to review and monitor the effectiveness of the support provided to meet eligible needs (as opposed to no duty to do so in this authority).

Wherever possible, the carer should be provided with signposting information as required to enable them to contact the Local Authority in which they are ordinarily resident. If they are likely to experience difficulty doing so then, with their consent, this can be done on their behalf.

If the carer insists that an assessment is carried out by this Local Authority, if they have an appearance of need, the assessment should be completed. In this instance, if the carer is subsequently found to have eligible needs, information gathered during the assessment should be shared with the Local Authority in which they are ordinarily resident so that they can decide with the carer how best to meet their needs moving forwards.

If the Local Authority in which the carer is ordinarily resident disputes ordinary residence, declines to carry out an assessment or declines to meet eligible needs following an assessment, legal advice should be sought. In all cases, the process of meeting eligible needs must not be delayed.

See the Ordinary Residence Procedure for further information about assessing and meeting the needs of people not ordinarily resident, and about managing ordinary residence disputes.

What to do when it is unclear from referral whether the carer is ordinarily resident in the area

Time should not be spent debating whether or not a carer is ordinarily resident in the area if this is not clear from referral. The carer is entitled to an assessment of need based on an appearance of need, and not whether they are ordinarily resident. To delay the process of meeting eligible needs whilst establishing ordinary residence would be unlawful. The assessment should therefore be completed and the question of ordinary residence resolved afterwards.

6. Clear and Unclear Outcomes

Clear Outcomes

If it is clear to you what further action is required, and you are authorised and confident to make this decision you should do so to avoid any unnecessary delays.

Unclear Outcomes

If it is not clear what further action is required or you are not authorised or confident to make this decision you should not commit to an action straight away, but discuss this with your line manager or a relevant colleague.

In all cases you should:

1. Assure the carer that their views have been heard and will be considered in any decision that is made; and
2. Agree with the carer when they can expect to hear from you again.

tri.x has developed a tool that can be used as required to support decision making following a contact or referral.

See: Contact or Referral Tool.

Disputed Outcomes

If you are sure that the action being requested is not appropriate you should be open about this in a respectful way.

You should:

1. Explain your reasons for thinking the action may be inappropriate;
2. Use professional expertise and evidence to support your rationale; and
3. If the individual making the contact or referral is a carer, be able to provide at least one other option for them to consider.

If you are in any doubt you should refer to the guidance in unclear outcomes above.

Where the action remains in dispute you must decide whether you are authorised and confident to make a final decision. If you are then you should do so. If not then you should follow the guidance set out in unclear outcomes above.

If the carer is not happy with the outcome of the contact you must make them aware of their right to complain about it.

When providing a carer with other option(s) you should also provide them with any support they need to explore those option (s) and to weigh up the pros and cons. Where option (s) have been provided to the carer in writing this may need to be followed up with a telephone response and if the carer appears to have difficulty communicating over the telephone consideration should be given to a face to face visit.

7. Gathering Information and Consulting with Others

Note: Information must only be gathered or shared with a third party if the carer has provided consent.

The purpose of gathering information and consulting with others

The purpose of consultation and information gathering is to ensure that the response of the Local Authority is a proportionate and appropriate one to the carer's situation and level of need. Only information relevant to this purpose should be gathered and shared during consultation.

All information gathering and sharing should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

Methods of consultation

The method of consultation and information gathering used should reflect the individual circumstances of the case. Depending on the level of urgency, risk and need consultation and information gathering can be formal or informal in nature.

For example:

1. A telephone conversation;
2. an e-mail or letter;
3. A video conference; or
4. A face to face meeting.

Where the method of consultation is not face to face you should be satisfied that the information you share will only be seen by the person for whom it is intended.

Where the Carer has requested the Local Authority Gather Information or Consult

You must consult with anyone that the carer with Support needs has asked you to consult with before making any outcome decision.

Consulting with Others

You should proactively identify anybody else that it may be appropriate to speak with in order to gather comprehensive information upon which to decide the most appropriate outcome. This could be a family member, the person that the carer provides care to, a health professional, another Local Authority or an organisation (such as a Care and Support provider).

8. Acting on Information about Risk

Information that a carer may be at risk

If you have received information that indicates a carer may themselves be a vulnerable adult at risk of abuse or neglect you will need to consider the measures that you (or others) can take to protect them.

Where a safeguarding concern has not been raised already you should raise a concern without delay.

See the Safeguarding Adults Procedure.

If you are concerned that the carer is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Information that a carer may be risky

If you have received information that indicates a carer may pose a risk to the person they are providing support to, or to others you will need to consider the measures that you (or others) can take to reduce the risk and protect those affected.

See: Risk Assessment.

If the risk assessment indicates that a vulnerable adult or child may be at risk of abuse and neglect you must ensure that you raise a safeguarding concern without delay.

See the Safeguarding Adults Procedure, which also includes information about how to raise a children's safeguarding concern.

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 dialing 999.

9. Communicating the Outcome

The outcome of the contact or referral should be communicated to the carer about whom it relates at the earliest opportunity and by the most appropriate practitioner. Often this is the practitioner who has been communicating with the individual making the contact or referral throughout, but if a manager or another professional has been responsible for the outcome decision consideration should be given about whether it may be more appropriate for them to communicate the outcome.

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 outcome of a contact or referral is subject to the same requirements as the provision of information and advice, and the duty to make it accessible therefore applies equally.

See: How to Provide Information and Advice to read more about how to provide information in an accessible way under the Care Act.

Where communication is to be provided by telephone a follow up letter confirming the conversation and outcome should be sent to the person as a formal record.

When communicating the outcome you should include the following information:

1. The outcome itself;
2. The rationale for the outcome, including who has been consulted and what evidence has been used to reach any decisions;
3. Any information and advice relating to adult Care and Support, and the prevention, delay or reduction of needs;
4. Where further action or follow up action is required, what will happen next, including timeframes for further contact;
5. How to complain about any aspect of the outcome; and
6. What to do if circumstances change in the future.

10. Recording Outcomes and Decision Making

Recording of decision making should be clear and comprehensive yet proportionate. Anyone reading the recordings should be able to (as quickly and easily as possible) understand what has happened and why a particular decision has been made.

When available it is important to capture in recordings:

1. The views of the carer with Support needs in regard to;
   • Their needs and what they would/would not like to happen;
   • The information and advice that has been given to them;
   • Any verbal consent given to gather information or consult with others; and
   • The possible outcomes that have been explored with them.
2. The details of and views of any other person or organisation consulted with as part of the decision making process;
3. Details of any manager or peer supervision discussions that have influenced the outcome decision;
4. Any actions agreed with anyone, including how any follow up will take place;
5. How the outcome has been decided, particularly how regard has been shown for individual Wellbeing, and how the decision prevents, delays or reduces the needs for Support;
6. How the outcome has been communicated and how it was received; and
7. How the situation will be monitored for changes.

Recording should take place as near to the time that the actual event being recorded took place and in line with local recording requirements.