Service Interruptions and Provider Failure

1. Service Interruptions

Recognising a Service Interruption

A service interruption occurs when:

  1. Any care and support service in the Local Authority area (regulated or non-regulated);
  2. Cannot provide services to one or more person (or carer);
  3. On a temporary basis.

Service interruptions can happen for a number of reasons, for example:

  1. Illness affecting a substantial number of the workforce meaning the service is temporarily unavailable or reduced;
  2. Illness affecting people with Care and Support needs meaning that a service is temporarily unavailable (e.g. a Norovirus breakout in a day service); or
  3. Business challenges facing an organisation meaning that some services may be temporarily unavailable.

Services meeting eligible needs

The Local Authority has a duty under the Care Act to:

  1. Meet needs that have been assessed as eligible; when
  2. Those needs are unmet needs.

As such the Local Authority must make alternative arrangements when:

  1. The service interrupted was meeting an eligible need; and
  2. No other appropriate arrangements can be made to meet the need.
Need to know
The duty to meet eligible needs applies equally to people who are self funding unless the service is a care home when the Local Authority has only a power to arrange alternative provision if it is asked to do so.

Services meeting ineligible or urgent needs

The Local Authority has a duty under the Care Act to:

  1. Meet unmet ineligible or urgent needs; if
  2. It has previously agreed to meet those needs.

In all other circumstances the Care and Support Statutory Guidance is clear that the Local Authority should consider using its power to meet urgent needs when:

  1. The service provider is not able to find a solution; and
  2. No other appropriate arrangements can be made (see below); or
  3. If the level of risk is high; or
  4. If the situation is likely to deteriorate into something unsustainable without Local Authority involvement.

If the Local Authority did not arrange the service

The Care and Support Statutory Guidance is clear that, even if it did not arrange the service, the Local Authority should consider using its power to meet urgent needs when:

  1. The service provider is not able to find a solution; and
  2. No other appropriate arrangements can be made (see below); or
  3. If the level of risk is high; or
  4. If the situation is likely to deteriorate into something unsustainable without Local Authority involvement.

The Local Authority has the power to:

  1. Meet the urgent need of any person or carer;
  2. Whether or not an assessment has been completed; and
  3. Whether or not the person is ordinary resident in its area; if
  4. That person or carer has an urgent need; and
  5. That urgent need is unmet.

Other appropriate arrangements

Other appropriate arrangements include:

  1. Arrangements made by the service provider;
  2. A self funder arranging an alternative service; and
  3. Informal care.
Need to know

Service providers have a responsibility to deliver the service being commissioned and should have a contingency plan in place setting out how they will respond to temporary interruptions in their planned service.

Contingency plans could include:

  1. Providing the service at a later/earlier time;
  2. Providing an alternative carer;
  3. Commissioning another provider to provide services on their behalf.

As such they should be encouraged to make alternative arrangements to meet the person's needs in the first instance.

Other arrangements are normally appropriate if:

  1. They are available;
  2. They are sustainable for as long as it is likely to be required; and
  3. They meets the person's eligible needs; and
  4. They do not increase the risk of harm or abuse to the person.

Arranging an alternative service

Alternative service should be arranged by the Local Authority when:

  1. The person or carer has urgent needs; and
  2. Those needs are unmet as a result of service interruption; and
  3. No other appropriate arrangements can be made to meet the need; and
  4. The Local Authority has a duty to meet the needs; or
  5. The Local Authority intends to use its powers to meet the needs.

Before arranging services you should identify any contingency plan that the Local Authority has in place that sets out:

  1. Any particular services that should be used; and
  2. Any specific processes for arranging them.
Need to know
If the alternative arrangements are temporary there is no requirement to amend any Care and Support Plan/Support Plan that may already exist.

Monitoring the situation

Appropriate and proportionate arrangements should be made to monitor the situation to ensure that:

  1. Alternative services are in place as intended; and
  2. They are meeting needs; and
  3. They are still required.

When the service interruption is over the original services should resume, with further care and support processes only necessary if:

  1. The original service fails and is permanently unavailable; or
  2. The person wishes to maintain the alternative services; and
  3. This is an available option and an appropriate way to meet on-going needs.

Reporting concerns about a service provider

If the service interruption raises concerns about the service provider you should consider the need to:

  1. Report a concern about them; or
  2. Raise a safeguarding concern.

See: Reporting Concerns about a Service Provider.

Also see the Safeguarding Adults Procedure.

2. Failure of a Non-Regulated Provider

Non-regulated providers

Non-regulated providers are those that are not required to be registered with the Care Quality Commission. This includes:

  1. Day services;
  2. Transport services; and
  3. Corporate appointeeship services.

Defining failure

Non-regulated service provider failure occurs when:

  1. A non-regulated service provider in the Local Authority area;
  2. Can no longer provide any services to any person (or carer);
  3. On a permanent basis.

Service failure normally has a wide reaching impact, and there will often be a need to find alternative services for a large number of people at the same time.

Responding to failure

The response to the failure of a non-regulated provider is the same response that should be given to a service interruption. This is set out above in Section 1, Service Interruptions.

3. Failure of a Regulated Provider

Regulated providers

Regulated providers are those that are required to be registered with the Care Quality Commission because of the nature of the service provided. They include:

  1. Services providing personal care;
  2. Services providing nursing care;
  3. Care home provision for people requiring personal care or nursing care;
  4. Care home provision for people requiring treatment for substance abuse;
  5. Treatment of disease, disorder (including learning disability) or injury; and
  6. Assessment or treatment of people detained under the Mental Health Act.

Defining failure

Regulated service provider failure occurs when:

  1. A regulated service provider in the Local Authority area;
  2. Can no longer provide any services to any person (or carer);
  3. On a permanent basis.

Service failure normally has a wide reaching impact, and there will be a need to find alternative services for a large number of people at the same time.

The duty to provide alternative provision

If a regulated provider in the Local Authority area fails the Local Authority has a temporary duty under section 48 of the Care Act to:

  1. Provide alternative care and support services (or support services); from
  2. The time that it becomes aware of the provider failure; until
  3. It no longer appears necessary for them to do so.

This duty applies regardless of whether:

  1. The person or carer is ordinarily resident in its area (or even the same country of the UK);
  2. The person is known to the Local Authority;
  3. The provider is known to or has a contractual arrangement with the Local Authority;
  4. The person makes their own care and support arrangements (either through a Direct Payment or is self-funding);
  5. The services were arranged by a different Local Authority;
  6. The Local Authority has carried out a needs or carers assessment;
  7. The Local Authority has carried out a financial assessment; or
  8. The needs apparent are eligible.
Need to know
The section 48 duty does not apply when the person was receiving Care and Support services through NHS Continuing Healthcare funding where the NHS would be responsible for ensuring the person's needs continue to be met.

How alternative provision must be arranged

The Local Authority is permitted to make the final decision about how best to meet the person's needs, so long as:

  1. All of the needs being met by the service provider before it failed are met;
  2. The person or carer is involved in the decision;
  3. Anyone else deemed relevant by the Local Authority is involved in the decision (for example a health professional or an advocate); and
  4. Disruption to the person or carer is minimised.

Because provider failure can often be anticipated the team responsible for commissioning services may have already made alternative large scale arrangements with another provider to meet urgent needs.

If such arrangements are in place you should use them.

If the person is not ordinary resident

See the Meeting the Urgent Needs of a Person who is not Ordinary Resident section of the Ordinary Residence Procedure, which sets out the steps that must be followed when meeting urgent needs of a person who is not ordinary resident.

Monitoring the situation

Appropriate and proportionate arrangements should be made to monitor the situation to ensure that:

  1. Alternative services are in place as intended; and
  2. They are meeting needs; and
  3. They are still required.

Meeting on-going needs

When urgent arrangements have been made consideration should be given to carrying out further care and support processes as required, including:

  1. Assessment (or reassessment) of a person's need for care and support;
  2. Assessment (or reassessment) of a carers need for support; and
  3. Care and Support Planning.