Deciding the Outcome of a Contact or Referral (Reablement)

1. Possible Outcomes

The possible outcomes of a contact or referral for reablement are:

1. Recording of information only (for example when a person makes contact to provide a short update on reablement);
2. The provision of information and advice;
3. Referral or signposting to another prevention service (for example a health service or an Occupational Therapist);
4. Allocation to establish or confirm reablement needs;
5. Transfer of the referral to another service in the Local Authority (if reablement is not deemed appropriate);
6. The review of an existing reablement plan; or
7. A combination of the above.

Unless reablement is not deemed an appropriate service for the person the likely outcome of the referral will be allocation for a reablement assessment and plan.

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.

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

2. What must be Considered

Legal Requirements

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:

1. The impact on the person's individual wellbeing;
2. Whether any other prevention service can be provided that will delay, reduce or prevent the need for Care and Support;
3. 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.

See: Promoting Individual Wellbeing for information about the duty to promote individual wellbeing.

See: Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs.

See: Providing Information and Advice.

Internal referrals

Internal referrals are those made by another adult social care team.

Internal referrals should only be made when:

1. A proportionate assessment of the person's needs has already been carried out;
2. The person making the referral is satisfied that the reablement service is an appropriate service to prevent, reduce or delay the person's needs;
3. The person making the referral has explained the reablement service to the person and sought their consent to make the referral; or
4. The person making the referral is satisfied that the person with Care and Support needs lacks capacity and the referral is being made in their best interests; and
5. The person making the referral is satisfied that the person is able to and willing to engage with the reablement service.

Unless there is new evidence to the contrary you should make arrangements to allocate and carry out a reablement assessment following an internal referral.

External referrals

External referrals are those made by the persons or organisations outside of adult social care.

When you are making a decision about the appropriateness of an external referral for a reablement assessment you must first answer the following questions:

1. Is the person aged 18 or above?
2. Does the person have an appearance of need?

If you answer 'Yes' to both questions then the person is entitled to an assessment of their needs and the Local Authority has a duty to assess in a proportionate and appropriate way.

To determine whether or not a reablement assessment is appropriate you should then consider the following:

1. Does the person appear to be open to being supported in an enabling way?
2. Does it appear the person wants to become as independent as possible?
3. Does it appear the person would be able to 'carry over' things from one day to the next.

If the person is under 18

Reablement cannot be provided to anyone under the age of 18, where any needs remain the responsibility of children's services to meet. If the person is under the age of 18 you should:

1. Explain to the person making the referral that the reablement service cannot be provided because the person is not yet 18; and
2. Agree when arrangements to provide reablement can be considered (if the person is going to become 18 soon); or
3. Provide information and advice about alternative prevention services (either directly or through signposting to children's information and advice services).

If the person does not have an appearance of need

If the person does not have any appearance of need (including a need that can be prevented, reduced or delayed) there is no duty to assess.

If the person has an appearance of need but a reablement assessment is not appropriate

If you feel that a reablement assessment is not an appropriate or proportionate way to assess the person's needs you do not have to proceed to carry out a reablement assessment but you must arrange for an assessment of need to be carried out by another service (for example a social work team.

Under no circumstances must you refuse the reablement assessment and close the case. The Local Authority has a duty to assess any person with an appearance of need and is in a breach of the Care Act if it fails to do so.

3. 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:

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 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 a reablement service, 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 persons needs in the context of their wider support network;
2. Helping the person to understand their strengths and capabilities within the context of their situation;
3. Helping the person to understand and explore the support available to them in the community;
4. Helping the person 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 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.

4. Ordinary Residence

Reablement and ordinary residence

Reablement can only be provided to people who are:

1. Ordinarily resident in the Local Authority area; or
2. Present in the area with no settled residence.

Under the Care Act there is no legal requirement to establish ordinary residence until after any assessment process has taken place. However, because the likely outcome of a reablement assessment is a reablement service it is prudent to establish ordinary residence prior to assessment.

How to establish ordinary residence

See what the Care Act says about Ordinary Residence, including understanding what ordinary residence is, how/when to establish ordinary residence.

tri.x has developed a tool to support decision making around ordinary residence.

See: Ordinary Residence Decision Support Tool.

See the Ordinary Residence Procedure for further information.

After accessing the available information in these procedures you should speak to your line manager if you are unclear about:

1. The ordinary residence status of the person; or
2. Whether to carry out a reablement assessment based upon ordinary residence status.

When the person is not ordinarily resident

If the person is not ordinarily resident in the Local Authority area (or present but with a settled residence elsewhere) you should not proceed to establish reablement needs as you will not be able to provide a reablement service.

However, as long as the person has an appearance of need they are still entitled to an assessment of their needs.

This means that under no circumstances must you proceed to close the case after refusing the reablement assessment on the basis of ordinary residence. The Local Authority has a duty to assess any person with an appearance of need and is in a breach of the Care Act if it fails to do so.

Instead, you should arrange for an assessment of need to be carried out by another service (for example a social work team).

What to do when it is unclear whether the person is ordinarily resident in the area

Time should not be spent debating whether or not a person is ordinarily resident in the area if this is not clear from referral. The person is entitled to an assessment of need based on an appearance of need, and not whether they are ordinarily resident. To delay the assessment whilst establishing ordinary residence would be unlawful.

The Local Authority should:

1. Complete the assessment to determine reablement needs;
2. Establish ordinary residence after determining reablement needs; and
3. If the person is not ordinary resident arrange for an appropriate service to establish eligibility for any urgent Care and Support required.

5. Clear and Unclear Outcomes

Clear Outcomes

If it is clear to you what action is required following a contact or referral, 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 action is required following a contact or referral, 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 person that their views have been heard and will be considered in any decision that is made; and
2. 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:

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 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 or referral 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:

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 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:

1. 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;
2. 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;
3. 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:

1. To gather information about the support they provide to the person; and
2. 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 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.

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 referral 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 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 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:

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.

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:

1. The views of the person with Care and Support needs in regard to;
   • Their reablement 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 views of any carer in regard to;
   • The needs of the person;
   • The reablement needs of the person 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.
3. The details of and views of any other person or organisation consulted with as part of the decision making process;
4. Details of any manager or peer supervision discussions that have influenced the outcome decision;
5. Any actions agreed with anyone, including how any follow up will take place;
6. Where there have been concerns about the person's mental capacity to consent to the contact or referral, 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;
7. 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.
8. How the outcome has been communicated and how it was received; and
9. 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.