Deciding the Outcome of a Contact or Referral (Occupational Therapy)

1. Possible Outcomes

Taken from the Care Act statutory guidance, the following are just some of the possible outcomes of a contact or referral:

Recording of information only;
The provision of Information and Advice;
Signposting to another prevention service (for example a housing prevention service or reablement);
Professional support without assessment;
Allocation for a needs assessment;
Transfer of the referral to another service in the Local Authority for an assessment (for example, social work);
Joint assessment with another service in the Local Authority;
Joint assessment with another Local Authority or organisation (for example, housing);
The review of an existing piece of equipment; 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.

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

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 provide equipment to aid independent living and talk through the adult Care and Support assessment process with him so he can talk to his mum about the benefit of an Occupational Therapy assessment. 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 arthritis and is finding it difficult to move around her home. She has called the Local Authority for help. A Local Authority occupational therapy provides professional support to Susan over the telephone and establishes that she would benefit from some grab rails around her home. A local housing prevention service is able to provide the rails and the Occupational Therapist signposts Susan to them.

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.

2. 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 other 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.

Need to know

The College of Occupational Therapists have written bespoke guidance that can be used to supplement the Care Act statutory guidance. Use the links below to access the guidance.

Wellbeing

Prevention

When the referral is for an adult needs assessment

When you are making a decision about the appropriateness of a request for a needs assessment you must answer the following questions:

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

If you answer 'Yes' to both questions then a needs assessment is appropriate and the person is entitled to an assessment.

If the person does not have an appearance of need there is no duty under the Care Act to assess. However, you should still consider whether carrying out an assessment will still be of benefit to them in terms of the prevention, reduction or delay of any future need for Care and Support.

You must be satisfied that the person is happy with any outcome provided to them that is not a formal assessment if they:

Requested a formal assessment of need; and
Have an appearance of need.

If the person is not happy and continues to request a formal assessment of need then the Local Authority has a duty under the Care Act to carry out such an assessment unless there is no appearance of need.

When the referral is for the needs assessment of a child

These procedures are specifically for the use of Occupational Therapy practitioners using the Care Act to establish the needs of adults.

If the referral is an assessment request for a young person who is under the age of 18 you should refer to available children's services procedures to consider the referral and carry out any subsequent assessment process. All children with a disability are entitled to a needs assessment under the Children Act 1989.

When the contact is for a Review of an Adaptation or Piece of Equipment

If a person is requesting a review of their equipment or adaptation because it is no longer meeting their needs a reassessment of need will be required to establish:

What the change in need is;
Whether needs are eligible for support under the Care Act (or the HGCRA); and
What the most appropriate and proportionate way to meet the need is.

If a person is requesting a review of their equipment because it is faulty, you should refer to available local guidance to confirm who is responsible for maintaining or repairing the equipment.

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 Local Authority 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, 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 their community;
Helping the person to understand and explore the support available to them through other networks or services (e.g. health and housing);
Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through other 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.

4. Ordinary Residence

What the Care Act says

See what the Care Act says about Ordinary Residence, including understanding what ordinary residence is, how/when to establish ordinary residence and how/when to meet the needs of people who are not ordinarily resident in the area.

To summarise, a person's eligibility for an assessment is not determined in any way by ordinary residence and is based solely on the appearance of need. Ordinary Residence must however be established before any eligible needs are met as the Local Authority only has a duty to meet the eligible needs of a person that is ordinarily resident in its area.

In practice, most Local Authorities will try to establish ordinary residence before carrying out an assessment, so that the assessment is carried out by the Local Authority that will subsequently be responsible for meeting eligible needs. However, an assessment cannot be declined on the basis that a person is not ordinarily resident in the Local Authority area.

How to proceed when it is clear from referral that the person is not ordinarily resident

If a person is not ordinarily resident, an assessment by the Local Authority that will not be responsible for meeting their eligible needs may not be in their interests or give them the outcome they are looking for. Information and advice should be provided to support the person (or the referrer) to understand ordinary residency and the benefits of having their needs assessed by the Local Authority in which they are ordinarily resident:

That the Local Authority in which they are ordinarily resident will have a duty to meet their eligible needs (as opposed to no duty to do so in this authority);
That the Local Authority in which they are ordinarily resident will have a duty to carry out Care and Support planning with the person to determine the best way to meet eligible needs (as opposed to no duty to do so in this authority); and
That the Local Authority in which they are ordinarily resident will have a duty to review and monitor the effectiveness of the support provided to meet eligible needs (as opposed to no duty to do so in this authority).

Wherever possible, the person (or referrer) should be provided with signposting information as required to enable them to contact the Local Authority in which they are ordinarily resident. If they are likely to experience difficulty doing so then, with their consent (or in their best interests if they lack capacity), this can be done on their behalf.

If the person insists that an assessment is carried out by this Local Authority, if they have an appearance of need, the assessment should be completed. In this instance, if the person is subsequently found to have eligible needs, information gathered during the assessment should be shared with the Local Authority in which they are ordinarily resident so that they can decide with the person how best to meet their needs moving forwards.

If the Local Authority in which the person is ordinarily resident disputes ordinary residence, declines to carry out an assessment or declines to meet eligible needs following an assessment, legal advice should be sought. In all cases, the process of meeting eligible needs must not be delayed.

See the Ordinary Residence Procedure for further information about assessing and meeting the needs of people not ordinarily resident, and about managing ordinary residence disputes.

What to do when it is unclear from referral 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 process of meeting eligible needs whilst establishing ordinary residence would be unlawful. The assessment should therefore be completed and the question of ordinary residence resolved afterwards.

5. Clear and Unclear 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 or referral 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 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). Under the Care Act anybody contacted by the Local Authority has a duty to co-operate with any requests for information or support.

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 Safeguarding Adults.

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 Safeguarding Adults.

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:

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 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;
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.