The Light Touch Review Conversation

1. When to use this Procedure

This procedure should be used to support a light touch review conversation as part of the statutory review of a Care and Support Plan.

If you are carrying out the review of a carer's Support Plan you should see: The Light Touch Review Conversation (Carers).

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

1. Hospital Pathway Team;
2. First Response Teams;
3. Review Teams;
4. All Age Learning Disability.

Light touch reviews

The primary focus of a 'light touch' review is to gather enough information to be satisfied that the Care and Support Plan is:

1. Working effectively as intended; and
2. There are no issues or adjustments needed to the Care and Support Plan.

During a light touch review there is only a requirement to 'touch' upon needs, Wellbeing and outcomes.

A light touch review is normally appropriate and proportionate whenever:

1. There are no known changes in need or circumstances; and
2. There are no changes required to a Care and Support Plan (or minimal changes to how existing Care and Support is provided only); and
3. There are no changes required to the personal budget.

A light touch review should be specifically considered in the following circumstances:

1. At the 6-8 week review; and
2. When there is/has been on-going monitoring of the person's needs or circumstance.

If a light touch conversation is not appropriate, see: The Full Review Conversation.

If you are not clear whether a light touch review is appropriate you should seek advice from your line manager.

2. The Light Touch Review Conversation and Mental Capacity

A light touch review can still be carried out when a person lacks capacity. The duty to maximise the person's involvement in the review process applies and as such, the light touch review should always be face to face, rather than a remote method of review.

The person with Care and Support needs should be supported to communicate their views during the review, either by an independent advocate (where the duty applies) or another appropriate person.

The views of any carer should also be sought, as should the views of anybody else that you deem it in the person's best interests to consult with.

You can also gather information by:

1. Spending time with the person to make your own observations about risk, outcomes, Wellbeing and needs; or
2. Using other available evidence to support you to understand what is working and not working with the Care and Support Plan, and what things may need to change (for example carer's notes and other records).

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

3. Carers and Families

Carers

Where the person is known to have a carer there is a requirement under the Care Act for the carer to be involved in the review process.

The purpose of doing so is:

1. To gather further information about the Care and Support Plan in regards the way it is meeting the needs of the person;
2. To understand any risk to the carer's role in the plan;
3. To identify any needs of the carer and fulfil the duty to meet them.

When a person has not consented to the carer being a part of the review you should:

1. Advise the person that you have a duty to involve the carer;
2. Explain the benefits of the carer being involved; and
3. Agree the most appropriate way to involve the carer (for example a separate meeting with the carer).

If the person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless doing so would put the person (or another vulnerable adult or child) at risk of abuse or neglect.

Families

The Care Act is clear that a whole family approach to review should be taken wherever possible. The whole family approach in review is the same as the whole family approach in assessment.

4. Reviewing what is Working and Not Working (Light Touch Review)

The impact on Wellbeing

A Care and Support Plan that is working well is more likely to have a positive effect on the person's Wellbeing than a plan that is not working well. The Local Authority has a duty to promote individual Wellbeing, so must ensure that everything is in place in the plan and working as intended.

What the conversation must establish

The conversation about what is working and not working must broadly establish whether:

1. All of the services and support in the plan are in place as intended;
2. All of the services and support in the plan are meeting the person's needs;
3. The plan is supporting the person to achieve their outcomes;
4. The method of managing the personal budget is still the most effective way of meeting needs and supporting the person to achieve outcomes;
5. Anything has changed about the person's circumstances that may indicate a change is needed to the Care and Support Plan;
6. There any risks to the plan's sustainability;
7. The plan is managing any identified risk to the person (including risk associated with their needs and risk relating to abuse and neglect);
8. Everybody involved in the plan is satisfied with it.

Appropriate and proportionate conversations about what is working and not working

A light touch review should only be carried out when it is known or thought that:

1. Everything in the Care and Support Plan is in place as intended;
2. The Care and Support Plan is meeting eligible needs;
3. The Care and Support Plan is meeting outcomes; and
4. The method of managing the personal budget is working.

As such, conversations about what is working or not working during a light touch review should reflect the fact that the plan is likely to be working well.

Simple questions should be used to confirm that the plan is working, such as:

1. Is everything in the Care and Support Plan in place as intended?
2. Are all the support and services you receive working well for you?
3. Does anything need to change about your plan or the way you are supported?
4. Does anything need to change about the way you manage the personal budget?

You should refer to the Care and Support Plan to confirm what support and services should be in place, and how the personal budget is being managed.

You should refer to the full review procedures if the response identifies that:

1. Support and services in the Care and Support Plan are not in place as intended; or
2. Support and services being provided are not working as intended.

5. Talking about Individual Wellbeing (Light Touch Review)

You have a statutory duty to promote individual Wellbeing at all times, including at review. However, because a light touch review should only be carried out when it is known or thought that there have been no changes to a person's Wellbeing, conversations about Wellbeing need to be proportionate and appropriate.

See: Talking about Individual Wellbeing.

6. Reviewing Outcomes (Light Touch Review)

Outcomes and Wellbeing

Outcomes can change when a person's life priorities change. This can happen unexpectedly and unmet outcomes can have a dramatic impact on a person's individual Wellbeing. The Local Authority has a duty to promote Wellbeing and to do this it must:

1. Understand what is important to a person to achieve, change or maintain in their life at any given point in time; and;
2. Take steps to support the person to achieve outcomes.

What the conversation about outcomes must establish

The conversation about outcomes must broadly establish whether:

1. The outcomes in the Care and Support Plan have been achieved or not;
2. The person has any new outcomes they want to meet; and
3. Any improvements are required to the plan to achieve better outcomes.

Appropriate and proportionate conversations about outcomes

A light touch review should only be carried out when it is known or thought that there has been no change to a person's outcomes.

As such, conversations about outcomes during a light touch review should reflect the fact that outcomes are unlikely to have changed.

Simple questions should be used to confirm that outcomes are being met by the Care and Support Plan, such as:

1. How have you been able to work towards the outcomes in your plan?
2. Have there been any changes to the things that are important to you to achieve, change or maintain?
3. Do you think there needs to be any changes to the plan to work towards your outcomes?

You should refer to the Care and Support Plan to confirm what the person's outcomes were.

The conversation about outcomes at light touch review may identify:

1. Additional information and advice that you can provide to support the person to take steps to meet the outcomes in their plan. Where this is the case you must provide such information and advice; or
2. Small changes only to the how the support in the Care and Support Plan needs to be provided to achieve outcomes (for example a change to the timing of the support).

You should refer to the full review procedures if the response identifies that:

1. The plan is not supporting the person to meet outcomes as intended; or
2. The person's outcomes have changed; and
3. There are likely to need significant changes to the Care and Support Plan to achieve outcomes.

7. Talking about Needs (Light Touch Review)

What the conversation about needs must establish

The conversation about needs must establish whether the person's needs have changed since the time that they were assessed and the Care and Support Plan agreed.

Proportionate and Appropriate conversations about need

A light touch review should only be carried out when the person is thought or known to have no changes in their needs.

As such, conversations about need during a light touch review should reflect the fact that needs are unlikely to have changed.

A simple question, such as 'Has there been any change to your needs' can be sufficient during a light touch review.

You should refer to the assessment report to confirm what assessed needs were.

Once you have established that there has been no change in need there is no requirement to discuss needs further during the review.

If there has been a change in need you should explore:

1. Broadly, what the changes in need are;
2. What the impact of the changes are on the person's Wellbeing;
3. What the impact of the changes are on any carer and formal services; and
4. The impact of the changes on risk (to the person and the plan).

If there has been a change in need the outcome of the review must be to carry out a proportionate reassessment of need.

The reassessment must make effective use of the information gathered during the review to avoid duplication.

Exploring and managing different views

If, as part of a light review process there is disagreement about whether a person's needs have changed it is your responsibility to make the final decision about whether needs have changed. To do this you should:

1. Consider all of the available evidence;
2. Give regard to the views of the person; and
3. Consider the different views expressed by others.

You must make sure that the evidence upon which you base your decision is robust and you must be open about the evidence that you have used.

Urgent and interim support

You will need to consider any requirement for urgent or interim support to ensure that the person's eligible needs are met whilst steps are being taken to:

1. Resolve the issues with the Care and Support Plan;
2. Agree revisions to the Care and Support Plan; or
3. Carry out any other action (for example safeguarding or a reassessment of needs).

If there is an urgent need to be met, see: Urgent or Interim Support.

Short term changes in need

If a person has experienced a change in need but this is only likely to be short term a reassessment of need is not required, as long as:

1. The needs can be met and are being met by the existing Care and Support Plan; and
2. It is reasonable to believe that the needs are short term only.

You will need to agree appropriate arrangements to monitor the person's needs and circumstances. This could be through another light touch review in a shorter time frame. You will also need to ensure that the person (or their representative if they lack capacity) knows what action to take should the short term needs become more long term or the Care and Support Plan no longer meets the needs.

8. Reviewing Risk (Light Touch Review)

Understanding what risk is

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

The aim of any conversation about risk is to maximise the benefits and reduce the likelihood of harm.

Why you must review risk

It is important to talk about risk during a light touch review for the purpose of establishing that:

1. Risks continue to be well managed by the Care and Support Plan;
2. There have been no changes to risk;
3. There is no risk to the person from abuse or neglect; and
4. There is no risk to the Care and Support Plan's stability or sustainability.

Appropriate and proportionate conversations about risk

A light touch review should only be carried out when it is known or thought that:

1. Risks to the person are unchanged and well managed; and
2. Any risks to the Care and Support Plan are mitigated through the contingency plan in place.

As such, conversations about risk during a light touch review should reflect the fact that risks are likely to be well managed.

Simple questions should be used, such as:

1. Are the things in the Care and Support Plan keeping you safe?
2. Is there a chance that your plan could stop working well?

You should refer to the Care and Support Plan to confirm the current contingency plan and risks being managed.

The conversation about risk at light touch review may identify:

1. Additional information and advice that you can provide to support the person to manage risk. Where this is the case you must provide such information and advice; or
2. Small changes to the Care and Support Plan contingency or the way in which Care and Support services manage risk.

You should refer to the full review procedures if the response identifies that:

1. The plan is not supporting the person to stay safe as intended; or
2. The contingency measures in the plan are not managing risk to the plan's sustainability; and
3. There are likely to be significant changes required to the Care and Support Plan.

9. Good Information and Advice and Prevention

The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for Care and Support applies at all times.

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

• 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.

During the review process it is important that you:

1. Offer information and advice as appropriate, including signposting to other sources;
2. Discuss options to prevent, reduce or delay the need for Care and Support; and
3. Give the person and anyone else involved opportunities to ask questions or seek clarity.

10. Safeguarding and Deprivation of Liberty

Safeguarding

If, as part of any conversation you have with a person or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately.

See the Safeguarding Adults Procedure, which also includes information about how to raise a concern about a person under the age of 18.

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.

Where the safeguarding is in respect of the person whose Care and Support Plan is being reviewed a decision will need to be made about the need to pause the review process to allow a safeguarding enquiry to take place.

There are 3 possible options:

1. The review process continues alongside any safeguarding process;
2. The review is paused with no on-going intervention by the person carrying out the review whilst a safeguarding process takes place; or
3. The review is paused but urgent interim support is arranged to ensure needs are met whilst a safeguarding process takes place.

Any decision should involve the person carrying out the review, the person who will be carrying out any safeguarding process, the person with Care and Support needs (or their representative) and any carer.

Deprivation of Liberty

You must consider any appropriate action required to authorise deprivations of liberty whenever:

1. The person lacks capacity to make decisions about the Care and Support provided to them; and
2. You feel the level of restriction being imposed on the person is depriving them of their liberty; or
3. You feel the level of restriction required to meet their care and support needs following any reassessment to take place is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.

11. Making Notes

It is quite appropriate to take notes during a review conversation to ensure that you are able to satisfactorily recall and capture what has been discussed and agreed in the formal record. However, there are some general good practice rules to follow when doing so:

1. Think beforehand about the level of note-taking that may be required-ensure you have to right tools and that they are proportionate;
2. Explain to the person and anyone else present that you will be taking some notes and why;
3. Reassure the person and anyone else present that you will still be listening to them even when you are making notes;
4. Don't record everything that is said. This will prevent you from engaging in the conversation and cause distraction-you need to pick out what is relevant and important;
5. Make sure you record everything that the person says is important to them, even if it does not appear to be relevant to you or others;
6. If the person uses a certain phrase that is powerful or indicative to the context you should record this word for word;
7. Sometimes information is detailed or complex and taking notes could take a little longer than expected. If this is the case you should consider making a polite request for a brief pause to allow for notes to be made;
8. Sometimes people provide a lot of information without a pause-perhaps they are anxious or simply have a lot to say. Trying to keep up can lead to you over-recording (recording everything regardless of relevance); missing key points, failing to understand what is being said or appearing disengaged from the conversation. If this is the case you should consider politely requesting a pause to allow for clarity and notes to be made;
9. Refer to your notes to summarise what has been said during the conversation, reflect and seek clarity about what has been agreed and next steps;
10. Try to make notes in a legible way and take care to use appropriate language-the person may request to see the notes or be provided with a copy;
11. Confidentiality must be maintained at all times. Make sure that the notes are kept securely and only available to people authorised to see them;
12. Always file or dispose of any notes securely when a formal record of the conversation has been made.