Chris Watson, our specialist adviser in adult social care and support, has written the following updates on adult social care issues:
25 March 2020 | The following information is also available as a download.
On 19 March the government introduced the Coronavirus Bill into parliament to enable public bodies to respond to the Covid-19 pandemic. The bill completed its passage through the House of Commons on 23 March and is now being considered by the Lords on 24 and 25 March ahead of achieving Royal Assent.
The Coronavirus bill effectively has three main aims:
- to give further powers to the government to slow the spread of the virus
- to reduce the resourcing and administrative burden on public bodies
- to limit the impact of potential staffing shortages on the delivery of public services.
What are the key proposed changes for people regarding Health and Social care?
Easing pressure on NHS and local authority resources
The bill allows NHS providers to delay assessment of a patient’s need for ongoing nursing care before discharging.
- The bill allows NHS providers to delay assessment of a patient’s need for ongoing nursing care before discharging.
- The bill eases, in exceptional circumstances, the requirements on local authorities to conduct a ‘needs assessment’ when it appears that an adult may have needs for care and support.
- The bill allows for powers to detain and treat patients for mental health disorders to be implemented using the opinion of fewer medical professionals (e.g. one doctor instead of two).
Some provisions of the bill (such as the emergency registration of health professionals) take effect on Royal Assent. Others only take effect when a government minister makes a regulation switching them on.
Power to turn provisions on and off
This allows ministers to make regulations to turn some measures in the bill on and off as needed.
Power to change the expiry date of the bill
Ministers may make a regulation to extend some provisions of the bill beyond the two year time period (for a maximum of six months). The time period may also be reduced.
Parliamentary debate on the bill after one year
The bill requires a parliamentary debate to be held in both Houses of Parliament one year after Royal Assent (so long as key provisions of the bill remain in force at that time).
What this might mean for you or your loved one regarding:
New assessments (or reassessments) by Local Authorities (LA’s) or Clinical Commissioning Groups (CCG’s)
Local Authorities and CCG’s will no longer have a duty to assess (or reassess) disabled adults or their carers either in relation to their care and support needs. The bill also removes current eligibility criteria and replaces these with the broader duty to meet needs where by not meeting them would again be a breach of human rights. LA’s and CCG’s can still carry out assessments if they wish to and have the resources to undertake them.
This change in provision should mean that LA’s and CCG’s are better able to cope with the volume of contacts that their care management teams are now having in relation to the impact of the pandemic, allowing more flexibility around keeping people safe and well supported. It also means that changes to existing support arrangements may be made by LA’s and CCG’s without the need to complete a formal ‘reassessment’. These measures are being designed to reduce bureaucracy, speed up processes and enable support to be provided quickly and flexibility to urgently meet changing needs in a time of crisis.
In reality, this may mean that people are now ‘fast tracked’ through normal processes to make sure that they get the help and care that they need without the normal procedural delays that are associated with carrying out written assessments.
It should not mean that people are left with significant unmet needs that place them at risk of significant harm.
As with assessments and re assessments the bill will allow local authorities to temporarily suspend or change the 4-6 week review for newly set up support packages/Direct Payments and also the statutory annual review.
This should mean that LA and CCG care management staff are free’d up from their day to day duties and are able to prioritise their work according to urgent need and to respond more rapidly to crisis situations as they emerge. Scheduled reviews therefore may or may not go ahead or may be done more quickly over the telephone rather than face to face.
It should not mean that anyone is left with significant unmet needs as a result of the cancelation of, or the rescheduling of a planned review
The bill will also mean that current weekly personal budgets or weekly Direct Payments may be increased or decreased to meet need without a formal assessment (or reassessment) taking place.
This should mean that LA’s and CCG’s are able to act more quickly in adjusting a person’s budget around their changing support needs and that support can also be delivered more flexibly by support providers, personal assistants and families who can now react more immediately to changes in need without having to seek permission to change the way they are delivering support (provided it does not breach the adults or carers human rights).
It should not mean LA’s or CCG’s reducing weekly personal budgets and Direct Payments arbitrarily without having a considered and justifiable reason. The budget should continue to be sufficient to ensure there is not a breach of the persons human rights.
Many support provider organisations are making changes to how they deliver their support to make sure that vulnerable people with the highest level of need are prioritised.
This should mean that, where necessary, some forms of non-essential support will be pared back, with the focus being primarily on keeping people safe and well in their homes prioritising the maintenance of essential nutrition, personal care and medication/medical arrangements.
This should not mean that people are left unsupported in meeting their critical needs (i.e. endangered).
Around the country many people are choosing to move temporarily back in with their families to self-isolate together. In these scenarios’ family members are often taking the place of support provider organisations (or personal assistants) to directly provide support for their son/daughter at home.
The flexibilities of the bill allow for this to happen without need to conduct a reassessment of the support package or penalties for support providers who are no longer delivering part or all of the service.
We consider this a practical and sensible response to the issues caused by Covid -19 to individuals, families and to the health and social care the workforce which is facing unprecedented difficulties with maintaining staffing levels around the country.
In some shared accommodation such as residential homes or group supported living visits from family and friends has been restricted to prevent the spread of Covid-19. This is entirely normal and is in compliance with the governments advice to care and support providers.
This should mean that people can choose to go home to live with families if they want (provided family are confidently able to meet their needs) and be supported positively and flexibly by LA’s, CCG’s and care provider organisations with this choice. Where people are in group living environments and unable to receive visitors efforts should be made to help people use alternative approaches to staying in touch such as video calls.
This should not mean that people are forced home by wider circumstances (unless it is a dire emergency) if it is not considered to be in their best interests. Families should not be left to care completely unassisted (unless they choose to be) and should be helped to think about and develop contingency plans if they themselves become unwell and are unable to care.
The entitlement to urgent help from LA’s and CCG’s still exists and will continue to do so. Many LA’s and CCG’s are drafting in extra staff to help them manage the crisis and are delivering extended opening hours but it may take longer to get a response from then than usual.
This should mean that urgent situations are still prioritised for LA/CCG intervention and that the delivery of care and support that is necessary to keep people safe and well continues to be delivered without undue bureaucracy. Care providers are empowered to work with disabled adults and families to react more quickly to changing needs and make adjustments to support arrangements in order to keep people safe.
This should not mean unreasonable delays in getting any urgent help that is needed for carers or vulnerable adults that will impact critically upon their safety.
19 March 2020 | The following information is also available as a download
Chris Watson, our specialist adviser in adult social care and support, has highlighted the changes to the Care Act 2014 in England in the new coronavirus bill.
We think, in essence, that local authorities will now be deploying social work staff to focus only on people who are at higher risk of some kind of support package/carer breakdown and it will mean that they stop most of their non-essential business as usual activities i.e. statutory annual reviews. We think it likely local authorities will target resources around reviews and assessments to only those people where some kind of urgent need has been identified that is life threatening.
Here is an extract of key text:
• make changes to the Care Act 2014 in England and the Social Services and Well-being (Wales) Act 2014 to enable local authorities to prioritise the services they offer in order to ensure the most urgent and serious care needs are met, even if this means not meeting everyone’s assessed needs in full or delaying some assessments. During a pandemic, a lot of people who work in health and social care could be off sick or may need to care for loved ones. This could mean that local authorities, which are responsible for social care, may not be able to do all the things they are usually required to do
Local authorities will still be expected to do as much as they can to comply with their duties to meet needs during this period and these amendments would not remove the duty of care they have towards an individual’s risk of serious neglect or harm.
These powers would only be used if demand pressures and workforce illness during the pandemic meant that local authorities were at imminent risk of failing to fulfil their duties and only last the duration of the emergency. It would ensure that local authorities will continue to be able to deliver the best possible care services during the peak and to protect the lives of the most vulnerable members of society.
• temporarily relax local authorities’ duties in relation to their duties to conduct a needs assessment and prepare an adult carer support plan/young care statement under the Social Work (Scotland) Act 1968, the Children (Scotland) Act 1995, the Social Care (Self-directed Support) (Scotland) Act 2013 and the Carers (Scotland) Act 2016 to enable them to prioritise people with the greatest needs.
Chris will post relevant information for you in this fast-changing situation.
Are you a parent/carer considering inviting your adult child to move into the family home from their own home in supported living, to self-isolate with you?
For people considered to have capacity to make the decision themselves, we would expect that choosing to temporarily move back in with family to self-isolate together will be fine provided this is done in discussion with both the local authority social work team and the supported living/residential care provider as part of contingency planning, and that the host family are both in agreement with taking on the primary carer role and are also sure that they are able to meet the persons assessed needs (and have a back-up plan if they themselves take ill).
If the person is considered not have capacity to make that decision then it would need to be made on a best interests basis including the persons family, social work team and support provider agency and, again, if the best interests decision was a yes then that would be absolutely fine.
Ultimately if families are willing to step in and provide care, and this meets all eligible needs outlined in their assessment (albeit these will be needs that now mainly manifest in the home environment, rather than community where access is now severely restricted) this will potentially be very helpful to the increasingly hard pressed care workforce and the NHS.
It is critically important to thoroughly think through contingency planning in both of these scenarios if the self-isolating family becomes infected and subsequently too ill to care themselves.
How might moving from supported living to the family home affect a person’s Direct Payments (DP)?
There isn’t any threat as such to DP arrangements en masse but again it is critical that there is a contingency in place for the Direct Payment holder/recipient if a support agency, personal assistant or family member is then unable to provide support due to illness.
Some Local Authorities have been contacting DP holders to support them to arrange contingency care and support if required.
I would advise families who are worried about a breakdown in their arrangement to contact social services for help in developing a back-up plan (as it may mean a temporary change to the weekly personal budget).
For people and families using Direct Payments it is therefore essential that they draw up plans to ensure continuity of care for the person should they, or their support network become ill and unable to provide support.
It is likely that some support provider organisations will withdraw from providing activity based support (i.e. going to gym’s, cafe’s clubs etc) and will instead focus their staffing hours more on the more critical life support functions such as providing direct personal care, helping people who are taken ill, and supporting people with essential tasks around food and shopping etc.
This is normal and should be expected, as more of the country self isolates community centric activities will become increasingly restricted anyway.