Actions and Next Steps (First Response)

You will often receive telephone contacts requesting to speak to a named worker or a particular service. However, this may or may not be the best person for them to speak to.

When the person/carer making the contact requests specifically to speak to or be contacted by a particular team or practitioner you should establish as quickly as possible whether the contact should be forwarded to that practitioner/team.

You should check available systems to establish whether:

1. The person/carer is allocated to the practitioner they have requested to speak to; or
2. The service/team is responsible for either the assessment or review of the person/carers needs.

You should not transfer a telephone call to a named worker if it is clear that the worker is not allocated to the person/carer. This will not be helpful to the worker or to the person/carer as they will not be speaking to the right person to resolve the contact.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a member of the service/team they are based in.

If you know when the practitioner is likely to become available you should:

1. Inform the person/carer of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and confirming the information given to the person about when to expect a call back;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required should the practitioner be unavailable for more than a few hours;
4. Agree with the person/carer what they should do if the practitioner does not make contact at the expected time; and
5. Make a proportionate record of all the above.

If it is not clear when the practitioner will become available you should:

1. Inform the person/carer of this;
2. Leave the practitioner a message alerting them to the contact, any action undertaken and what information has been given to the person/carer;
3. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required; and
4. Agree with the person/carer what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

When a written contact is addressed to a named worker you should establish as quickly as possible whether the contact should be forwarded to that practitioner.

You should check available systems to establish whether the person/carer is allocated to the practitioner that the written contact is addressed to.

You should not transfer a written contact to a named worker if it is clear that the worker is not allocated to the person/carer. This will not be helpful to the worker or to the person/carer as they will not be dealing with the right person to resolve the contact.

Before transferring the contact you should:

1. Confirm that the practitioner the written communication is being transferred to is available within a reasonable timeframe for the action indicated by the contact, or that there is a mechanism in place for the written contact to be received and managed by the service in which they work;
2. Where the communication is a letter or an e-mail, whether the practitioner wishes to receive the original contact (if not this should be filed securely); and
3. Where a written response confirming the contact has been received is required or requested, agree who will provide this.

The most secure way to transfer a written contact is to send a message to the practitioner alerting them to the contact and where it can be found on the recording system.

Any original copies of e-mails must be sent via internal secure e-mail systems only and any original letters must be sent via internal postal services or secure delivery only.

If the practitioner is not available

If the practitioner is not available you should try and establish when they may become available by looking at any electronic calendars they use or speaking with a member of the service/team they are based in.

If the practitioner is not available within a reasonable timeframe for the action indicated by the contact you should:

1. Leave the practitioner a message alerting them to the contact, where it can be found on the recording system and any action undertaken, including what has been agreed with the person/carer if contact has been made with them;
2. Undertake any actions that you are able to in order to resolve some or part of the contact, including any urgent actions that may be required and writing any acknowledgement letter to confirm arrival of the contact;
3. When the practitioner is not available within any timeframes indicted in the written contact or for more than a few days inform the person/carer making the contact of this;
4. Agree with the person/carer what they should do if the practitioner does not make contact within an agreed timeframe; and
5. Make a proportionate record of all the above.

If the information gathered during a telephone contact suggests the person/carer would benefit from further assessment or intervention a referral should be taken so long as:

1. The person/carer the referral relates to is making the referral;
2. The person/carer the referral relates to has given their consent to the referral; or
3. The person/carer that the referral relates to lacks mental capacity to make a referral and a decision has been made under Best Interests that a referral should be made; or
4. The person that the referral relates to is at risk of harm from abuse or neglect.

The following information should be included in a referral:

1. All personal details, including the persons/carers full name (and also preferred name or previous surname), address and preferred contact details, date of birth, national insurance number and NHS number;
2. The name, relationship and contact details of the person making the referral (if not the person/carer themselves);
3. When and how the person/carer consented to the referral;
4. If the person has not consented to the referral, was a mental capacity assessment carried out and is the referral being made under Best Interests;
5. What the presenting issue is from the person's/carer's perspective and what they would like to happen;
6. What the presenting issue is from the referrer's point of view (if the referrer is not the person/carer) and what action they may recommend;
7. What options have been considered with the person/carer to resolve the issue so far, including what support the person/carer has had from family and community networks;
8. What information and advice has been provided to the person or what information and advice may be required;
9. What prevention services have been used, considered or may be of benefit;
10. Any specific communication needs of the person/carer that need to be considered so they can understand and be involved in any adult Care and Support process;
11. Whether the person/carer is likely to have substantial difficulty in any adult Care and Support process, and if so whether an independent advocate has been considered;
12. Details of any previous or current Care and Support/Support services (whether the Local Authority is providing them or not);
13. With the person's/carer's consent the name and contact details of anyone involved in their life who should be involved in any assessment (family member, friend or professional); and
14. Any other information deemed relevant by the person/carer or referrer (if the referrer is not the person/carer).

Sometimes it is clear which service in the Local Authority should receive the referral that has been made. Where this is clear local processes should be followed to transfer the referral to that service.

Sometimes it is less clear which service should receive a referral. For example, if the person/carer's needs could potentially be met by more than one team.

Decision making in this instance should be as simple and consistent as possible. It should involve the person/carer and the potential services with the aim of reaching a shared agreement. Any delays should not negatively impact the person/carer or put them at risk through the delay of any Care and Support/Support needs being met.

Though not a requirement, it would be prudent to apply the same criteria that the Care Act requires to be applied when deciding the most appropriate worker:

1. The views and wishes of the person/carer about which service/team would best support them must be regarded;
2. The service/team must possess the skills, knowledge and competence to carry out the anticipated Care and Support functions; and
3. The service/team must possess the skills, knowledge and competence required to work with the particular person/carer in question.

tri.x as developed a tool that can be used a required to support consistent decision making about team suitability.

See: Team Suitability Decision Support Tool

The service area or team receiving the referral should make effective use of the information gathered thus far and not make the person/ carer (or anyone else previously consulted) repeat information unnecessarily.

Whenever the outcome of a contact or referral is that the person/carer will be involved in any adult Care and Support process (including any assessment, review, reassessment or safeguarding) the Local Authority has a duty under the Care Act to make an independent advocate available to the person/carer when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the person/carer would experience substantial difficulty being fully involved in the Care and Support process without support.

Decisions about the need for advocacy should be made as early as possible because advocacy must be provided before the Care and Support function to be carried out can begin. As such if you know that advocacy will be likely you should discuss this with the person and make a referral at the same time as you transfer the request for a review or reassessment.

The Local Authority has a duty to provide good information around finances at an early stage. This provides people with an understanding from the beginning about how they may be expected to contribute financially towards the cost of any Care and Support/Support they receive so that they can start thinking about and planning how they could use their financial resources flexibly to fund a range of potential care options. You should take any opportunity to provide this information, and should particularly make sure that it has been provided whenever a transfer is made to another service that may result in an assessment, review or reassessment.

See: Specific Requirements on the Provision of the Information and Advice around Finances for guidance on the requirements of the Care Act.

See the Financial Assessment and Charging FAQ Response Support Tool for the answers to some frequently asked questions around financial assessment.

Whenever the outcome of a contact or referral is that the person/carer will be involved in any adult Care and Support process (including any assessment, review, reassessment or safeguarding) the Local Authority has a duty under the Care Act to make an independent advocate available to the person/carer when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the person/carer would experience substantial difficulty being fully involved in the Care and Support process without support.

Decisions about the need for advocacy should be made as early as possible because advocacy must be provided before the Care and Support function to be carried out can begin. As such if you know that advocacy will be likely you should discuss this with the person and make a referral at the same time as you transfer the request for a review or reassessment.

The Local Authority has a duty to provide good information around finances at an early stage. This provides people with an understanding from the beginning about how they may be expected to contribute financially towards the cost of any Care and Support/Support they receive so that they can start thinking about and planning how they could use their financial resources flexibly to fund a range of potential care options. You should take any opportunity to provide this information, and should particularly make sure that it has been provided whenever a transfer is made to another service that may result in an assessment, review or reassessment.

See: Specific Requirements on the Provision of the Information and Advice around Finances for guidance on the requirements of the Care Act.

See the Financial Assessment and Charging FAQ Response Support Tool for the answers to some frequently asked questions around financial assessment.

There are a range of functions that can be carried out on behalf of any allocated team/worker.

These functions include:

1. Arranging urgent or interim support (for someone awaiting allocation) (see section 11 below);
2. Urgent assessment or review (see section 12 below);
3. The provision of minor adaptations or a low level equipment (see section 9 below);
4. Updating a Care and Support Plan/Support Plan (where there is no change in need or personal budget);
5. Suspending or restarting a service (for example, if a person is admitted to or discharged from hospital);
6. Arranging respite already agreed as part of a Care and Support Plan.

Proportionate records should be made of all action carried out and the allocated worker/responsible team should be alerted.

Some of the functions carried out may require an element of review or monitoring.

You should seek to reach an agreement with the allocated worker/responsible team about how any follow-up actions or monitoring will take place. This decision should give regard to the views and wishes of the person/carer about how they would like any follow up action or monitoring to take place.

Where the allocated worker/responsible team or someone else is going to follow up on the action you have taken (rather than following up on it yourself) you must make sure that you have recorded this in a way that will ensure this takes place at the agreed time.

Haricare

This is a comprehensive online information and advice service.

See: Haricare.

Adviceline

Adviceline is a partnership between Citizens Advice Haringey, HAIL, Public Voices, and Haringey Council. It can provide free information, advice, and guidance on a range of issues affecting people living in Haringey - including welfare benefits, debt, housing, and employment - and a searchable directory to help you find local agencies to meet your need for advice services.

Tel: 0300 330 1187
Online: haringeyadvice.org.uk

Carers

Carers FIRST delivers the Carers Service across Haringey supporting people who look after a relative or friend who due to ill health, physical or mental illness, disability, frailty, or addiction cannot manage without their support. Carers can access bespoke information and advice by calling 0300 303 1555.

Information about equipment and adaptations

If someone may need help to make their life easier, whether that's moving around their home or keeping track of their medication, AskSARA can point them in the right direction.

See: AskSARA.

Sometimes it is helpful to contact a well known national organisation with a dedicated information and advice service or help-line. See: National Organisations with Information and Advice Helplines for details of some national organisations offering this service.

Some national organisations do not have dedicated information and advice services but can still provide such support upon request. See: National Contacts for Adult Care and Support for a wider range of useful national contacts for adult Care and Support.

You can also see the Financial Assessment and Charging FAQ Response Support Tool for the answers to some frequently asked questions around financial assessment, including questions relating to Disabled Facilities Grants.

Information and advice must be provided in an accessible way so that the person/carer for whom it is intended can best understand and make use of it.

If you feel the person/carer for whom the information and advice is intended will need support to understand it then you should:

1. Consider whether the person/carer has anyone appropriate who can help them to understand it;
2. Consider any steps that you can take to support them to understand it (for example talking through the information over the telephone or summarising it in a simpler format); and
3. Consider the benefit of independent advocacy.

Sometimes the information gathered at contact, referral or through consultation with others will evidence that the most appropriate and proportionate response is to provide minor works or low-level equipment.

When arranging minor works and low-level equipment (either directly or through a partner agency) you must ensure that appropriate mechanisms are in place to:

1. Support the person (and any carer) to use the equipment provided safely;
2. Monitor the effectiveness of the works and equipment; and
3. Review the need for further assessment or intervention.

You should refer to available local guidance to confirm which works and equipment can be provided through the minor works scheme.

See: Minor Adaptations and Low Level Equipment.

Whenever the outcome of a contact or referral is that the person/carer will be involved in any adult Care and Support process (including any assessment, or safeguarding) the Local Authority has a duty under the Care Act to make an independent advocate available to the person/carer when:

1. There is no appropriate other person to support and represent them; and
2. They feel that the person/carer would experience substantial difficulty being fully involved in the Care and Support process without support.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool

The Local Authority also has a power (but not a duty) to make advocacy available in other situations on a case by case basis if it deems this appropriate and is able to do so. This could include advocacy to support a person/carer to understand information and advice, or advocacy to support a person/carer to explore possible options available to them.

Having substantial difficulty is not the same as lacking mental capacity.

See: Determining Substantial Difficulty for information about how to determine substantial difficulty.

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

An appropriate person for general representation purposes is not the same as an appropriate person for independent advocacy under the Care Act.

See: An Appropriate Other Person for information about the difference and how to establish whether there is already an appropriate person.

The role of an independent advocate appointed under the Care Act is not the same as the role of a general advocate or any other type of advocate (for example an Independent Mental Capacity Advocate or an Independent Mental Health Advocate).

An independent advocate appointed under the Care Act must both facilitate and ensure the involvement of the person/carer with substantial difficulty in the Care and Support process that is taking place.

For information about the ways in which an independent advocate should fulfil their role, see: The Role of an Independent Advocate.

People who lack capacity will likely be legally entitled to advocacy under both the Care Act and the Mental Capacity Act 2005.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or whether any important decisions are likely to be the outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool

People eligible for an Independent Mental Health Advocate (IMHA) under the Mental Health Act 1983 will likely be entitled to advocacy under the Care Act.

The Care Act statutory guidance recognises that it would not normally be appropriate or practical for a person to have 2 advocates and gives the Local Authority the responsibility to make a decision about the best type of advocacy support.

There are various factors that should influence this decision (such as existing rapport with an advocate or the likely outcome of the Care and Support process) and the Local Authority must ensure that whatever it decides, it does not deny the person any of the specialist advocacy skills they need or are entitled to.

tri.x has developed a tool that can be used as required to support effective and consistent decision making about when/which advocacy support should be made available.

See: Advocacy Decision Support Tool

The advocacy referral can be made at any time and should be made without delay as soon as the duty applies.

Regardless of whether or not independent advocacy is available in the local area the duty to provide it still applies. A failure to do so is a breach of this duty and of the law. It is the role of commissioners to ensure that advocacy services are in place and available when required, and it is the role of practitioners to make timely referrals to advocates to prevent unnecessary delays in the meeting of its duty.

If you are aware that advocacy support is required and is not yet available you must not proceed to carry out any Care and Support process until it is in place.

In some circumstances, urgent interim measures may need to be agreed without an advocate in place in order to reduce immediate risk to the person/carer from inaction. However, Care and Support processes that will decide long term and important decisions must not be carried out without advocacy support.

The duty upon the Local Authority is to make independent advocacy support available to any person/carer who requires it. Once made available the duty is met.

If a person/carer decides that they do not wish to engage in the advocacy support that has been made available to them they do not have to do so, but the Local Authority must still provide it.

The Local Authority is expected under the Care Act to support the person/carer to understand the role of an advocate and promote its benefit to them so as to reduce the likelihood that they will not engage.

Not everyone contacts the Local Authority in a timely way so as to allow for an assessment and exploration of options to take place prior to any initial decisions being made about the need for Care and Support.

For example, some people only approach the Local Authority when they are in a time of crisis, high risk or when there is a sudden or unexpected change in their Wellbeing.

In these cases there may appear to be an urgent need for support that cannot wait for an assessment or review process to be carried out.

The Care Act recognises this occurrence and gives the Local Authority powers to meet such needs without having carried out a formal assessment process.

To see what the Care Act says about meeting urgent needs without an assessment or review, see: The Power to Meet Needs.

Having the power to meet needs without an assessment or review means that the Local Authority can decide whether or not to do so, based on the available information and specific circumstances of the person/carer and their situation.

Under the Care Act, the Local Authority can put any interim or urgent measures in place that it deems appropriate to meet the needs of the person/carer and manage the situation. This can range from a small number of domiciliary care visits to a stay in residential accommodation.

The same legal considerations apply when meeting urgent needs as they do when meeting non-urgent needs:

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

In addition, you should be mindful that nobody has yet assessed (or reassessed) the needs of the person/carer and you may be relying on historical information or information from sources currently under significant strain or pressure to act. As such the information presented may or may not be an accurate reflection of the person's/carer's needs following an assessment.

Interim support should therefore only be seen as a temporary measure to reduce risk of harm and support the person/carer to a place in time where a needs or carer's assessment can be carried out and long term options explored and agreed with them. As such, you should be cautious about providing interim Care and Support/Support that may be problematic to cease following assessment.

tri.x has developed a tool that can be used as required to support consistent decision making about the provision of urgent or interim support.

See: Urgent or Interim Support Decision Tool

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

1. Taking a holistic view of the person or carers needs in the context of their wider support network;
2. Helping them to understand their strengths and capabilities within the context of their situation;
3. Helping them to understand and explore the support available to them in the community;
4. Helping them 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 prevention services or signposting).

For information and guidance about strengths-based approaches in Haringey you should refer to our Strength-based Practice Practitioner Manual. This can be found in the Practitioner Manuals and Policies section of the Local Resources.

All funding requests for urgent and interim support should be made in line with available local processes and requirements.

It can be difficult to make a decision about the level of funding required to meet the urgent or interim Care and Support/Support needs because:

1. There will be no personal budget allocated to the person/carer; or
2. There will be a personal budget but this will not be based on their current needs.

The Care Act does not discuss or set funding limitations in relation to the provision of any Care and Support/Support. This includes urgent and interim Care and Support/Support. Instead, the golden rule of the Care Act when making any funding decision is that 'the amount of funding agreed must be sufficient to meet the needs that are to be met at that time'. Decisions must also be made in a way to ensure that the person/carer will be satisfied the process was fair and robust.

Other than sufficiency, the factors that decision makers must consider are:

1. The views and wishes of the person/carer about how their needs should be met;
2. The availability of other potential options in the marketplace; and
3. The cost of available suitable services in the marketplace.

Other factors that should be considered are:

1. The complexity of the needs;
2. The level of risk/sense of urgency; and
3. Whether the practitioner requesting the funding has provided relevant information and advice, whether they have explored prevention services that may be appropriate and whether they have explored how the person's/carer's own networks of support could help; and
4. Where the person/carer is not ordinarily resident; if they receive Care and Support/Support already in another Authority the nature of the Care and Support/Support they receive.

Decision makers should also take into account that the Local Authority is also permitted under the Care Act to consider how to balance its legal requirement to maintain universal services to the entire local population with the power to meet urgent needs. In doing so it must:

1. Not base it's decision on finances alone;
2. Consider things on a case-by-case basis; and
3. Not set arbitrary limits (fixed amounts for a particular type of need or service).

The outcome of the funding decision should be communicated to the person/carer at the earliest opportunity. The method of communication should reflect that requested by the person/carer and any specific communication needs they may have. For the purposes of the Care Act communication about the outcome of a funding decision is subject to the same requirements as the provision of information and advice, and the duty to make it accessible therefore applies equally.

Where communication is provided by telephone a follow up letter confirming the conversation and the funding decision should be sent to the person/carer as a formal record.

When communicating the outcome you should include the following information:

1. The funding decision itself;
2. The rationale for the decision;
3. Any information and advice relating to adult Care and Support, and the prevention, delay or reduction of needs;
4. What will happen next and the timeframes involved;
5. How to complain about any aspect of the decision or proposed outcome.

Any funding decision rationale should be clearly recorded in line with local recording requirements.

The Local Authority is not required to record urgent and interim support on a Care and Support/Support Plan because:

1. The support is being provided under the Local Authority's powers (as opposed to duties);
2. The person/carer has not yet been assessed (or reassessed); and
3. There has been no decision about eligible needs.

However, the following must be clearly recorded:

1. The urgent or interim support being provided;
2. The contribution to the cost of the support being made by the Local Authority;
3. The contribution being made by the person/carer;
4. The duration of the support;
5. How the support will be reviewed;
6. What outcomes the support aims to achieve; and
7. The next steps, including timeframes for any assessment.

Under the Care Act the process of arranging to meet urgent and interim Care and Support needs is the same as arranging to meet needs agreed through a non-urgent Care and Support Planning (or Support Planning) process.

The Local Authority is permitted under the Care Act to charge any person/carer for Care and Support/Support (including Care and Support/Support provided on an urgent basis) unless:

1. It chooses not to; or
2. The person/carer has been financially assessed as having insufficient funds to contribute; or
3. The support being provided is reablement (up to 6 weeks is non-chargeable); or
4. The support being provided is equipment (up to the cost of £1000 is non-chargeable).

For further information about charging for all services under the Care Act, see: Power of the Local Authority to Charge.

It is your responsibility to understand the position of the Local Authority in regards to the financial assessment of carers.

See the Financial Assessment Procedure for further guidance.

Where urgent support is provided to a person/carer who is not ordinarily resident contact should be made at the earliest opportunity to the Local Authority in which they live to inform them of the intention to meet an urgent need.

Where the person/carer is already in support of a service from the other Local Authority information should be gathered to support any decisions made about which support should be provided.

Agreement should be reached with the other Local Authority about how any urgent Care and Support/Support services will be monitored, when they intend to assess for eligible needs and how reimbursement of costs incurred can be sought.

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

See: Ordinary Residence Decision Support Tool

Also see the Ordinary Residence Procedure for further information.

Where the decision is for the person/carer's case to be allocated to an individual worker to carry out an urgent assessment, review or other intervention this allocation should take place in a timely way so as to:

1. Avoid any unnecessary delays to the person/carer;
2. Reduce the risk of a deterioration in the situation; and
3. Maximise the use of measures that will prevent, delay or reduce needs.

The Care Act recognises that each worker (regardless of whether or not they have a professional qualification) will possess specific skills, knowledge and experience that will enable them to carry out different Care and Support functions or work with particular people well.

Because of this there is no expectation that a particular role should carry out a particular function; instead the Local Authority should allocate tasks to the most appropriate person for the job.

Allocation decisions should take into account:

1. The skills, knowledge and experience of the worker in carrying out the function or process required;
2. The skills, knowledge and experience of the worker in working with the particular needs of the person/carer (for example health needs or communication needs); and
3. The views and wishes of the person/carer themselves in relation to the skills required of the worker and who they feel would best support them.

tri.x has developed a tool that can be used as required to support allocation decisions.

See: Allocation Support Tool