Deciding the Outcome of a Contact or Review Request (Review Teams)

1. Using this Procedure

This procedure should be used to decide the outcome of a contact or review request regarding a person with Care and Support needs. It should not be used when the contact or review request was in regard to a carer.

If the contact or review request relates to a carer, see Deciding the Outcome of a Contact or Referral (Carers).

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 review request.

Recording of information only;
The provision of Information and Advice;
The provision of a preventative service (or supporting access to a prevention service provided by a partner organisation such as health);
Professional support without review;
Allocation for a review;
Transfer of the request to another team (where appropriate);
Joint review with another service in the Local Authority;
Joint review with another Local Authority or organisation (for example, health); or
A combination of the above.

The outcome should not be prescribed or predetermined by factors such as the financial resources the person 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 person at that time. Additionally, there should not be variance between outcome decisions made about people who have similar needs in similar circumstances.

Case Examples

Example 1:

Greg has contacted the Local Authority because his mum is getting older and is finding some household chores more difficult than she used to. He doesn't know what help is available and is also worried about the future. The Local Authority provides Greg with contact details for various agencies that offer help with domestic chores and talk through the adult Care and Support assessment process with him. They also provide the details of a financial advice organisation so that Greg can find out what the financial implications of any future Care and Support needs may be for his mum.

Example 2:

Susan has been unwell lately and is lacking in confidence to do her weekly shopping. She has a computer and has been purchasing heavier items online but misses the social aspect of shopping and would like to be able to do a smaller shop in person. She has called the Local Authority for help. The Local Authority establishes that, while Susan has a large network of friends they all work and are not able to commit to supporting her with this. It is agreed that a referral will be made to the reablement service for a few weeks to support Susan to gain confidence to achieve her goal of carrying out a small shop each week.

Example 3:

Matilda has been recently diagnosed with a long term progressive illness. This has thus far affected her mobility but is likely to impact on other areas of her life over the coming months and years. Matilda has a good network of family support that is willing and able to continue supporting her with meeting most needs, although they are finding manual handling problematic. The Local Authority agrees for a social worker and an occupational therapist to complete a joint assessment of Matilda's needs. This approach will ensure that current manual handling needs are met, that strategies for preventing or delaying the development of other needs are agreed, that carers needs are understood and supported and that options for the future are discussed and explored at an early stage.

3. What must be Considered

Legal Requirements in all cases

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

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

Requests to Review or Revise an Existing Care and Support Plan

Under the Care Act, when a person is already receiving Care and Support from the Local Authority they may request a review of their Care and 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.

Any request for a review that is made at a time when there is a statutory responsibility to review at that time is reasonable. If these are the circumstances of the request a review must be arranged and carried out at the earliest opportunity.

Deciding whether a review request made at any other time is 'reasonable' involves considering a number of factors before making a professional judgement. These include:

a. Is the information on which the request is being made accurate?
b. If a review has been carried out in the last 6-8 weeks, has there been a change in need or circumstance?
c. Is the Care and Support Plan still working as intended?
d. Are the eligible needs identified at assessment being met?

Click Here to access a tri.x tool that can support decision making following a request to review.

Reassessment requests

Before undertaking a reassessment of the person's needs a proportionate light touch review of the current Care and Support Plan should take place to answer the following specific questions:

Has there been a change in the person's circumstances?
Has there been a change of need (either temporary or permanent)?
Is the current Care and Support Plan likely to be able to continue meeting the person's needs?

A reassessment of need is not required if:

There has been no change to the person's needs; or
The current Care and Support Plan is able to continue meeting the person's needs.

If there is any doubt about the above a reassessment should be carried out.

4. A Strengths Based Approach

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

Anything within their own power that they can do to help themselves; or
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 person 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:

Taking a holistic view of the persons needs in the context of their wider support network;
Helping the person to understand their strengths and capabilities within the context of their situation;
Helping the person to understand and explore the support available to them in the community;
Helping the person to understand and explore the support available to them through other networks or services (e.g. health);
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. Contact 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:

Assure the person that their views have been heard and will be considered in any decision that is made; and
Agree with the person 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:

Explain your reasons for thinking the action may be inappropriate;
Use professional expertise and evidence to support your rationale; and
If the individual making the contact is a person with care and support needs, 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 person is not happy with the outcome of the contact you must make them aware of their right to complain about it.

When providing a person with care and support needs with other options(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 person in writing this may need to be followed up with a telephone response and if the person appears to have difficulty communicating over the telephone consideration should be given to a face to face visit.

6. Gathering Information and Consulting with Others

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 person'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:

A telephone conversation;
an e-mail or letter;
A video conference; or
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 Person has requested the Local Authority Gather Information or Consult

The Care Act is clear: Apart from cases where the level of risk is paramount you must consult with anyone that the person with Care and Support needs has asked you to consult with before making any outcome decision.

Examples of paramount risk could include:

Where urgent action is required, that if delayed to allow consultation would place the person at imminent risk of abuse or neglect leading to serious harm;
Where the person to be consulted is deemed to be the perpetrator of abuse and neglect and consulting with them at that time would place the person (or another vulnerable adult or child) at imminent risk leading to serious harm;
Where urgent Care and Support provision is required, that if delayed to allow consultation would place the person at imminent risk of harm through the non-meeting of essential needs.

The person should be told why consultation has not occurred, and long term decision making should be avoided until such time when consultation is possible.

Consulting with carers

Where the person is known to have a carer the Care Act expects you to consult with them before making any decision regarding Care and Support for the person.

The purpose of doing so is:

To gather information about the support they provide to the person; and
To understand the needs of the carer and fulfil the duty to meet them.

Where the person with Care and Support needs does not consent to you consulting with their carer you should explain to them that you must still do so for the purposes above. However, the consultation should be limited to that purpose and other information about the circumstances of the person should not be shared or discussed.

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, a health professional, another Local Authority or an organisation (such as a Care and Support provider).

With the consent of the person the Local Authority is permitted under the Care Act to consult with anybody it deems it relevant to consult with, and anybody contacted by the Local Authority has a duty to co-operate with requests for information or support.

See: Co-Operation to read more about the duty to co-operate under the Care Act.

Consent to Consult and Mental Capacity

If there are concerns that the person may lack capacity to consent to you gathering information from or consulting with others then a mental capacity assessment must be carried out to determine whether this is the case. This should be carried out by the Local Authority because it is the Local Authority who wishes to consult.

If the person has capacity to consent following the mental capacity assessment their consent must be obtained before consulting others.

If the person lacks capacity to consent following the mental capacity assessment then a Best Interest Decision must be made to confirm that consulting with others will be in their Best Interests. This decision should be made by the Local Authority because it is they who will be consulting.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing capacity and making best interest decisions.

7. Acting on Information about Risk

Information that a person may be at risk

If you have received information that indicates a person may be 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 person 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 person may be risky

If you have received information that indicates that a person may pose a risk to others you will need to consider the measures that you (or others) can take to reduce the risk and protect others.

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.

8. Communicating the Outcome

The outcome of the contact or review request should be communicated to the person 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 review request 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 person 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:

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

9. 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:

The views of the person with Care and 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.
The views of any carer in regard to;
- The needs of the person;
- 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.
The details of and views of any other person or organisation consulted with as part of the decision making process;
Details of any manager or peer supervision discussions that have influenced the outcome decision;
Any actions agreed with anyone, including how any follow up will take place;
Where there have been concerns about the person's mental capacity to consent to the contact or review request, to consent to consultation with others or to be part of the decision making; a record of how mental capacity has been assessed and how any best interest decisions have been made;
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 Care and Support;
How the outcome has been communicated and how it was received; and
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.