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Monitoring and Review (Occupational Therapy)

1. Monitoring

Monitoring is the primary 'review' type function used by Occupational Therapy practitioners.

When monitoring should be considered

Monitoring should always be considered when:

  1. Equipment is provided short term only;
  2. There are delays in providing equipment or an adaptation;
  3. There is a need to maintain involvement and direct support was deemed disproportionate;
  4. It is not clear whether the person or carers will use equipment effectively; or
  5. Further intervention in the short term may be likely (for example reassessment or direct support).

The purpose of monitoring

The purpose of monitoring is to:

  1. Confirm that equipment is meeting eligible needs as intended; or
  2. Establish whether equipment that is provided on a short term basis is still required; or
  3. Confirm that any urgent or interim direct support or equipment being provided is meeting needs as intended; or
  4. Establish progress in the provision of equipment or an adaptation; or
  5. Identify the need for additional support to use equipment safely and effectively; or
  6. Review the effectiveness of equipment in meeting needs that fluctuate; or
  7. Identifying the best time to re-assess needs (when this was anticipated).

Agreeing monitoring arrangements

Monitoring arrangements must be agreed with:

  1. The person (or their representative if they lack capacity); and
  2. Any carer.

The frequency and method of monitoring should be proportionate to the nature of the equipment being provided, and the needs and circumstances of the person. It could include:

  1. Face to face visits to the person (required if they lack capacity);
  2. A meeting involving the person, any carer and any service providers that use the equipment;
  3. Telephone contact with the person, any carer and any service provider;
  4. E-mail communication.

Monitoring arrangements should be clearly recorded. Where you are making arrangements for another practitioner to carry out monitoring activity (rather than providing it yourself) you must make sure that you have recorded this in a way that will ensure monitoring activity takes place at the agreed time.

Gathering information and consulting with others

When monitoring you should make effective use of any information that is available about:

  1. The effectiveness of the equipment being provided;
  2. The person's needs or circumstances.

Information could include:

  1. Records of contact with the person, carer or provider in between formal monitoring activity;
  2. Reports from professionals (for example a social worker or GP);
  3. Records relating to safeguarding concerns or enquiries.

Recording monitoring activity

Any monitoring activity carried out should be clearly recorded. In particular you should record:

  1. Whether the equipment, works or adaptation is meeting needs as intended;
  2. Whether there have been any issues with the equipment;
  3. Whether the person still requires the equipment (when it was provided short term);
  4. Whether any changes to monitoring activity are required.

Altering monitoring activity

Decisions about altering monitoring activity must be made with regard for:

  1. The views of the person;
  2. The views of any carer;
  3. The impact of the decision on the person's Wellbeing.

You should seek the advice of your line manager about the need to alter monitoring activity if this is not clear.

Whenever monitoring activity is altered you must record:

  1. The rationale for any decision made;
  2. How you have given regard to the person's views and the impact of the decision of Wellbeing; and
  3. How you have given regard for the views of any carer.

Ending monitoring

Indicators that it may be appropriate to end monitoring include:

  1. The person and any carers are consistently using equipment safely;
  2. Equipment is being used appropriately and effectively to meet needs and promote independence;
  3. Everyone who was identified as being in need of direct support has received it;
  4. There are no concerns about sustainability of safe use.

Upon ending monitoring you must provide the person (or their representative if they lack capacity) with the following in writing:

  1. Information and advice about maintaining and repairing equipment;
  2. Any other information and advice requested, or that you feel would be beneficial;
  3. What they should do if their needs change;
  4. What to do if the equipment no longer appears to be meeting their needs; and
  5. What they should do if they (or a carer) requires further direct support in the future to use the equipment safely.

You should familiarise yourself with available local guidance that confirms who is responsible for maintaining or repairing equipment in a range of circumstances.

Closing the case

You can proceed to close the case when:

  1. There are no outstanding actions for the Occupational Therapy service following monitoring; and
  2. The person has been provided with all information and advice required (or that would be beneficial) as set out above.

2. Review

There is no statutory responsibility to specifically review the on-going effectiveness of equipment, works or adaptations provided under the Care Act or any other legislation.

However:

  1. There is a statutory responsibility to meet eligible needs; and
  2. There is a statutory responsibility to review a Care and Support Plan; and
  3. There is a duty to review manual handling plans under the Manual Handling Operations Regulations 1992 (MOR).

The Care and Support Plan Review

If equipment is part of a Care and Support Plan and you have been actively involved in providing direct support or monitoring equipment, works or an adaptation you should:

  1. Establish when the statutory review of the Care and Support Plan is going to be carried out; and
  2. Notify the practitioner or service with responsibility for carrying it out of your involvement.

In all other cases you only need to partake in the review of a Care and Support Plan when requested to do so by the practitioner or service with responsibility for its review.

Note: If you have been asked to provide information as part of a statutory Care and Support Plan review you should provide:

  1. The information that has been requested; and
  2. Any other information that you feel is relevant to the review process.

All information sharing should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

Note: If you receive a formal request to take part in a joint Care and Support Plan review you must co-operate with this request unless by doing so you are prevented from carrying out your own duties under the Care Act or any other legislation.

For further information about the duty to co-operate under the Care Act, see: Co-Operation.

Following the review you should be provided with, or given access to a copy of any formal written record made, which you should read to ensure that it reflects what was discussed, agreed and the overall outcome of the review. If you feel amendments are required you should consult with the practitioner or service that prepared the record. It is their responsibility to decide whether to make the amendments.

You should make your own proportionate record of the review conversation in the person's file if:

  1. You feel it is appropriate to do so; and
  2. Doing so will be of benefit for the purpose of monitoring or the provision of direct support.

Manual Handling Plans

All manual handling plan reviews should take place in line with local processes and requirements.

3. Reassessment

If the process of monitoring or review identifies there has been a change in the person's needs you must arrange to carry out a proportionate reassessment.

The process of reassessment is the same as the process of assessment.

4. Removing or Changing Equipment

Removing equipment that is no longer required

If no replacement equipment is needed and the person simply no longer needs what is in place (for example if they move into a care home that provides the equipment) you should make arrangements for the equipment to be returned to stores. This is regardless of whether the item is:

  1. Standard stock;
  2. Non-standard stock;
  3. Specialist equipment.

This should be done in line with local processes and requirements.

If the equipment is recorded on a Care and Support Plan you must notify the practitioner responsible for maintaining and reviewing the plan of:

  1. The equipment that has been removed; and
  2. The basis on which the equipment was removed.

You can consider closing the case when:

  1. Any old equipment has been removed; and
  2. There are no outstanding actions for the Occupational Therapy service.

Changing Equipment

If monitoring, review or direct support identifies that equipment may no longer be required because of a change in need you must carry out a proportionate reassessment of need to determine that:

  1. The person's needs have changed; and
  2. The equipment is no longer the most appropriate or proportionate way to meet needs.

You should not remove existing equipment until replacement equipment is in situ unless:

  1. Continued use of existing equipment poses significant risk to the person or carer; or
  2. The existing equipment is unsafe because it is faulty.

You should make arrangements for the old equipment to be returned to stores. This is regardless of whether the item is:

  1. Standard stock;
  2. Non-standard stock;
  3. Specialist equipment.

This should be done in line with local processes and requirements.

If the equipment is recorded on a Care and Support Plan you must notify the practitioner responsible for maintaining and reviewing the plan of:

  1. The equipment that has been removed;
  2. The basis on which the equipment was removed; and
  3. Any new equipment that has been provided.

You can consider closing the case when:

  1. Any old equipment has been removed;
  2. You have confirmed that any new equipment is in place and being used as intended to meet eligible needs;
  3. There is no need to provide direct support or monitoring;
  4. There are no outstanding actions for the Occupational Therapy service.

Before closing the case you must provide the person (or their representative if they lack capacity) with the following in writing:

  1. Information and advice about maintaining and repairing the new equipment;
  2. Any other information and advice requested, or that you feel would be beneficial;
  3. What they should do if their needs change; d. What to do if the equipment no longer appears to be meeting their needs; and
  4. What they should do if they (or a carer) requires further direct support in the future to use the equipment safely.

5. The Provision of Information and Advice

The duty to provide good information and advice applies at all times.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

  • Providing Information and Advice (Care Act 2014) for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it;
  • Providing Information and Advice, which includes access to local and national information and advice resources (general and specialist).

6. Accessing another Prevention Service

Occupational Therapy is one of a range of services available where the focus is on the prevention, delay or reduction of needs. However other prevention services may also be beneficial alongside Occupational Therapy and should also be explored. These could include health services, reablement or Telecare.

Under Section 2 of the Care Act the Local Authority has a duty to prevent needs for Care and Support/Support whenever it identifies an opportunity to do so.

See: Preventing Needs for Care and Support to read more about the duty to prevent needs for Care and Support, including the types of prevention services recognised by the Care Act, when to provide prevention services and how to charge for prevention services.

7. Safeguarding and Deprivation of Liberty

Safeguarding

If, as part of any conversation you have with a person or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately.

See Safeguarding Adults, 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.

If the safeguarding concern has been raised during a statutory review a decision will need to be made about the need to pause the review process to allow a safeguarding enquiry to take place.

Deprivation of Liberty

You must consider any appropriate action required to authorise deprivations of liberty whenever:

  1. The person lacks capacity to make decisions about the Care and Support provided to them; and
  2. You feel the level of restriction being imposed on the person is depriving them of their liberty; or
  3. You feel the level of restriction required to meet their care and support needs following any reassessment to take place is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.

8. Reporting Concerns about a Service Provider

Why it is important to report concerns

Under section 5 of the Care Act the Local Authority has a duty to maintain an effective and efficient market of services for meeting Care and Support needs in the local area. A key part of maintaining a market place is understanding what is working and not working about the marketplace. It is therefore important that you report any concerns you have about any organisation providing any kind of Care or Support.

The local marketplace includes:

  1. Services that are commissioned by the Local Authority;
  2. Services that are provided by the Local Authority (for example, Reablement);
  3. Services used by self funders and people who have a Direct Payment;
  4. Universal services available to all residents; and
  5. Services provided by partner agencies (for example health or voluntary services).

Managing risk to the person

In all cases, you must take appropriate steps to manage the risk to an individual posed by the poor practices of a service provider. Effective ways of managing the risk could be:

  1. Raising a Safeguarding concern;
  2. Arranging an alternative provider (there is a duty to do this when a regulated provider fails);
  3. Agreeing monitoring arrangements.

Regulated Care and Support services

The commissioning service are responsible for ensuring that regulated Care and Support services are safe and of a high standard when:

  1. They are commissioned by the Local Authority (services provided in the Local Authority area or outside of it); or
  2. They are being used by people who have a Direct Payment (services in the Local Authority area); or
  3. They are available to people who self fund or use a Direct Payment (services in the Local Authority area only).

You should notify the commissioning service if you have general concerns about any of the following:

  1. Domiciliary Care Providers commissioned by the Local Authority (either in the local area or outside of it);
  2. Domiciliary Care Providers available in the local area but not commissioned (used by people with a Direct Payment or self-funders);
  3. Residential and nursing homes commissioned by the Local Authority (either in the local area or outside of it)
  4. Residential and nursing homes available in the local area but not commissioned (used by self-funders);
  5. Reablement services provided or commissioned by the Local Authority;
  6. Regulated day services (those providing personal care) commissioned by the Local Authority or available in the local area;
  7. Any other regulated Care and Support provision (for example Care and Support provided as part of a residential college placement).

Where you are providing details about a particular incident involving a person with Care and Support needs you should:

  1. Make the person aware that you are raising the concern and why; and
  2. Establish whether they consent to be contacted as part of any further information gathering if required.

The commissioning service will determine the most appropriate response to the concern that has been raised, which could include:

  1. Contract renegotiation with a commissioned provider;
  2. Agreeing and monitoring an action plan with the provider;
  3. A temporary stop on the use of a provider;
  4. A large scale safeguarding response;
  5. Joint work with another Local Authority (when the provider is not local);
  6. A recommendation to information and advice services not to signpost to a provider;
  7. Notification of concerns to the Care Quality Commission;
  8. A letter to people who use a service.

You may be asked to support the commissioning service by providing additional information or assisting in any investigation process they undertake. You are required to co-operate with any request under the Care Act unless doing so will:

  1. Prevent you from effectively carrying out other duties under the Care Act; or
  2. Prevent you from effectively carrying out duties under any other legislation.

Unregulated Care and Support services

Unregulated Care and Support services are generally services that do not provide personal care, and so do not have to be registered with the Care Quality Commission. They include:

  1. Some day services;
  2. Prevention services provided by housing;
  3. Health services;
  4. Colleges and training centres;
  5. Advocacy services;
  6. Voluntary and charitable services.

If the services are commissioned by the Local Authority you should report concerns to the commissioning service in the same way that you would report a concern about a regulated Care and Support service.

If the services are provided by a partner organisation (such as health, housing or education) there will be local arrangements in place to report concerns. If you do not know what these arrangements are you should:

  1. Speak to your line manager; or
  2. Speak to the commissioning service.

Where you are providing details about a particular incident involving a person with Care and Support needs you should:

  1. Make the person aware that you are raising the concern and why; and
  2. Establish whether they consent to be contacted as part of any further information gathering if required.

Personal assistants

When concerns arise about the practice of a personal assistant you should discuss your concerns with:

  1. The person with Care and Support needs (or their representative if they lack capacity);
  2. Any carer; and
  3. The person receiving the Direct Payment (if this is not the person or the carer).

Depending on the nature of the concern it could be resolved through:

  1. A conversation with the personal assistant to discuss the concerns and identify action required to resolve them;
  2. The provision of training to the personal assistant (for example manual handling training);
  3. A review of the working conditions and requirements in the contract to make sure that the tasks to be completed are clear.

If specialist information or advice is required or requested (for example relating to employment law) you should contact a suitably qualified person or organisation as required.

If presenting issues cannot be resolved or you remain concerned about the continued suitability of the personal assistant you should consider:

  1. Any monitoring arrangements required;
  2. The need to add a condition to the Direct Payment, that the Direct Payment cannot be used to employ the personal assistant; or
  3. The need to end the Direct Payment.

Any decision must have regard for:

  1. The views of the person with Care and Support needs;
  2. The views of any carer;
  3. The views of the person receiving the Direct Payment (if this is not the person with Care and Support needs); and
  4. The impact on the person's Wellbeing.

You should seek the advice of your line manager and the team responsible for managing Direct Payments as required.

Concerns about a personal assistant providing support to others

If you know that the personal assistant is providing Care and Support to other individuals in the local area you must consider any further action required. This could be:

  1. Notifying the team responsible for managing Direct Payments of the concerns so they can take appropriate action to notify others;
  2. Raising a safeguarding concern in respect of another individual being supported by the personal assistant.

Concerns about a personal assistant who is part of a local register

When a personal assistant is part of a local register of PA's it is important that any unresolved or on-going concerns are reported to the organisation or person responsible for managing the register.

This will allow for the register to be updated and consideration given to the on-going suitability of the PA to be included on it.

9. Whistleblowing

When to raise concerns

The Local Authority values openness, transparency and candour and encourages you to raise concerns as soon as possible about the practice of any individuals (whether they are employed by the Local Authority or not) that you feel:

  1. Compromises the safety or Wellbeing of a person with Care and Support needs; and/or
  2. Compromises the safety or Wellbeing of a carer with support needs; and/or
  3. Compromises the safety of a child.
Examples of individuals employed by the Local Authority include;
  1. A social worker;
  2. An occupational therapist;
  3. Unqualified workers in social work or occupational therapy services;
  4. Support workers in Local Authority day or provider services;
  5. Individuals employed in other areas of the organisation (such as housing officers and teachers in Local Authority schools or colleges).

Examples of individuals employed by other organisations include:

  1. Health professionals (for example a community or district nurse, a GP, a Psychiatrist or Psychologist, a Speech and Language Therapist. An Optician or a Dentist);
  2. Police Officers;
  3. A support worker in a charitable organisation;
  4. An advocate.

The legal context for Whistleblowing

Whistleblowing is part of the Public Interest Disclosure Act 1998 (PIDA). Under the Act you:

  1. Must be provided with a safe space in which to raise the concerns;
  2. Must be taken seriously;
  3. Cannot be subjected to any detrimental or unfavourable treatment and victimisation by the Local Authority or individuals as a result of making a disclosure.
Need to Know:

If you are a student you are not protected by the Public Interest Disclosure Act. Prior to raising a concern you should seek advice from your University tutor, lecturer or mentor, a trade union or the Whistleblowing Helpline (details below).

Providing evidence of concerns

Legally you do not have to provide any hard evidence to support a whistleblowing disclosure, but if you have any evidence you should always provide it. This could be:

  1. Details of when a specific incident occurred;
  2. A witness statement written by you or that has been provided to you;
  3. Other documentary evidence (for example an e-mail or letter).

Further advice

If you require further advice about whistleblowing before making a disclosure you can contact the Whistleblowing Helpline:

  1. By telephone on 08000 724 725;
  2. by e-mail at enquiries@wbhelpline.org.uk.

Raising a concern

Concerns should be raised in line with local whistleblowing policy and process.

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