Deciding the Outcome of a Reablement Review and Making a Formal Record

1. Deciding the Outcome of a Reablement Review

Possible outcomes of a reablement review

Broadly there are 3 possible outcomes following review:

  1. Reablement will continue with no changes required to the Reablement Plan; or
  2. Reablement will continue with some changes to the Reablement Plan; or
  3. Plans will be made to end reablement.

Depending on which outcome is decided a range of actions could be required, including:

  1. Changing monitoring arrangements;
  2. Revising the Reablement Plan;
  3. Planning to end reablement;
  4. Accessing another prevention service; and
  5. Providing information and advice.

Deciding the outcome through the review conversation

Throughout the process of review you should talk to the person (or their representative) and others about the likely outcome of the review, endeavouring to reach an agreement about this as the process progresses.

The responsibility for deciding the outcome

The Local Authority is responsible for making the final decision about the outcome of the review. As such this is your responsibility as you are the Local Authority's representative.

Considerations when deciding the outcome of the review

When determining the outcome of the review you must give regard to:

  1. The views of the person about the outcome;
  2. The impact of the outcome on the person's Wellbeing;
  3. The views of any carer about the outcome; and
  4. The views of anyone else consulted or involved in the review process.

The decision that you make about the outcome of the review must be evidence based and robust. This means you must be able to demonstrate the information that you have used to reach a decision if challenged.

The decision you reach may be in line with the views of the person (and others) but equally it may not be if the evidence does not support that judgement. This is appropriate as long as you have a clear rationale for your decision and can demonstrate that you have given regard to the person's views, their Wellbeing and the views of others.

Example:
Ahmed is of the view that his reablement service is working well towards meeting his outcomes but that he has not yet achieved them. The reablement worker has been providing information through monitoring that evidences Ahmed has been carrying out the outcomes in his plan independently for almost a week. This has also been the feedback from his mother, who has been visiting him daily to check on his progress. A decision is made that based upon the evidence the reablement service is no longer appropriate and arrangements are made to withdraw it. This is not the outcome that Ahmed wanted but the evidence supports the decision that is made.
Example:
Peter has a degenerative health condition. He tells you that he has achieved all of the outcomes in his reablement plan to the best of his ability and does not see the benefit in continuing. However, the Occupational Therapist explains that she has recently ordered some new equipment that she is confident will enable Peter to be more independent when preparing meals. She would like for the reablement service to continue working with Peter to see if better outcomes can be achieved. From the evidence available you decide that the outcome of the review should be for reablement to continue subject to further monitoring and review and Peter consents even though this was what he had originally felt.

If you are unclear about the outcome of the review you should consider the benefit in gathering any additional information or consulting with any other person. If you remain unclear about outcome you should seek advice from your line manager about how best to proceed.

2. Managing Disagreement about the Outcome

There may be times when the person, their representative or another person disagrees with the decision you have made about the outcome of the review.

In this situation you should be open to reviewing the available evidence and your rationale to ensure that the decision you have made is robust. You should be open and transparent about the evidence sources you have used and take steps to try and support the person to understand the decision you have made.

Where ongoing disagreement persists you should:

  1. Seek the support and advice of your line manager as required;
  2. Make a record of any difference of opinion in the formal record of the review;
  3. Ensure the evidence upon which you have based your decision is robust;
  4. Make sure that the regard you have given to the views of the person (and others) and the impact on their Wellbeing is clear; and
  5. Make proportionate records of any conversations you have had to try and resolve the differences.

You must also make the person (or their representative) aware of their right to complain about the decision that has been made.

3. Making a Formal Record of the Review

You are responsible for establishing the current review framework used by the Local Authority for recording a review. If you are unclear you should speak to your line manager before proceeding to make a formal record of the review.

The timeframe for making a record

Reviews should be recorded in a timely way and in line with local requirements.

Timely recording will:

  1. Reduce the likelihood of inaccuracies;
  2. Prevent any unnecessary delays for the person; and
  3. Ensure that any reassessment of need can make effective use of the information gathered at review.

If the timeframe for review that you use leads to inaccuracies or a delay in meeting needs then it is not timely.

What should be included in the record

The following information should be clearly but proportionately recorded in all cases:

  1. Whether the different elements of the Reablement Plan are in place and working as intended (and the evidence for this);
  2. Progress that has been made towards outcomes in the Reablement Plan (and the evidence for this);
  3. The views of the person and any carer about the progress of reablement;
  4. Who has been involved in reablement and the role they have played (including family, friends and other service such as occupational therapy);
  5. Steps taken to support the person to achieve general outcomes identified at assessment;
  6. Where issues were identified, what these were and the steps taken to resolve them;
  7. Whether reablement is still appropriate and needs to continue; and
  8. The views of the person and any carer about the need to continue reablement.

If reablement is to continue you should also record the following:

  1. Why a decision has been made to continue reablement;
  2. Whether any changes are needed to the reablement plan (e.g. to outcomes) or service delivery (e.g. frequency/duration of visits or involvement of others);
  3. Whether any changes are needed to the monitoring arrangements; and
  4. When the next review will be.

If reablement is to end you should record the following:

  1. Why a decision has been made to end reablement;
  2. When it may be appropriate to end reablement;
  3. Whether the person has any likely needs for on-going Care and Support;
  4. If so, whether these needs are already being met through an existing Care and Support Plan;
  5. If not, what action needs to be taken to ensure likely needs are confirmed, eligibility determined and eligible needs met.

Providing a copy to the person

Following the review process the person must be given a written record of their review.

It is important that the person understands their review and the outcome of it. To this end it should be provided in a format that is accessible to them.

If the review record has been provided in a format that you know or suspect the person will not be able to understand you should:

  1. Consider any steps that you can take to support them to understand it (for example talking through the review over the telephone or summarising it in a simpler format); and
  2. Consider the duty to make an independent advocate available.

If an advocate is already involved they should be informed when the review has been provided to the person so that they can support them to understand it.

Providing a copy to others

Where the review was carried out jointly with another organisation to avoid duplication (for example occupational therapy) a copy of the review must be made available to the other person that carried it out with you.

A copy should normally be shared in full with any carer unless the person has capacity and has asked you not to share the review, or to share only part of the review. In this case you will need to discuss and agree which elements of the review are to be shared having regard for confidentiality.

In all other cases a copy of the record can only be shared with the person's consent (or in their best interests if they lack capacity to consent).

A copy must also be shared with anyone that the person requests you share a copy with, even if they were not involved in the review itself.

Concerns about a request

You must provide a copy of the review to anyone that the person requests you to unless:

  1. They lack capacity and you make a decision that sharing would not be in their best interests; or
  2. You are concerned that doing so could put the person (or another vulnerable adult or child) at risk of abuse or neglect.

If this situation arises you should seek advice from your line manager and decide whether:

  1. To share the record in full as requested;
  2. To share the record partially, omitting sections where information could put the person at risk; or
  3. To decline to provide a copy of the record (although the person can of course still choose to make a copy available from their own record).

Amending a review record

Sometimes the person (or their representative if they lack capacity) or anyone else that was involved in the review may ask for amendments to be made to the record. For example:

  1. They feel that there is information missing; or
  2. They feel that the record is a misinterpretation of something that was said or agreed.

In this case you should:

  1. Consider the request;
  2. If the person whose review it is has not made the request, consult with them (or their representative if they lack capacity); and
  3. Review any evidence or information you have which may support or refute the request.

You should not make the amendment regardless of the existence of evidence and a rationale for doing so. If you reach a decision not to amend the record you should be clear about your reasons for not doing so, and you should make the person aware of their right to complain about your decision.

If a decision is made to make the amendments you should proceed to do so. Where doing so results in 2 versions of the same review being available on the system it must be clear which the amended version is.

The amended record should be circulated to the same people as the original record, unless the person requests otherwise or there is evidence that doing so would put the person (or another vulnerable adult or child) at risk of harm or abuse.