Fair access to care services (FACS): prioritising eligibility for care and support
Support planning - Personalisation and personal budgets: implications for practice
Putting People First sets out a vision where all people in receipt of social care support and their carers should be in control of their own lives, using personal budgets to direct the funding available to them to meet their needs in the way that suits them best.(‘Personalisation and support planning’, DH, 2010, para 119)
Mrs Christodoulou’s story – making choices with a personal budget
Mrs Christodoulou, aged 46, lives alone. Her son lives some distance away, but contacts her daily and visits fortnightly. A wheelchair user because of her disability, she uses her managed personal budget for personal care three times a week. Care workers become concerned when Mrs Christodoulou refuses to let them in twice in one week. Discussion with her son and her care manager results in Mrs Christodoulou identifying the outcomes she wants to achieve and her support plan is changed to use one of her personal care visits with a carer escorting her to her church social club.
The section of the 2010 DH Guidance on ‘Personalisation and support planning’ identifies the vision for social care support to promote control and choice for people, and lists what should be included in a care and support plan. This can be used for reference when working with people and recording the agreed care plan. To ensure effective and holistic support planning, staff need to:
- involve individuals, with their carers, relatives and social networks, in developing
their own care and support plan by:
- promoting their capacity to use direct payments and personal budgets, and to contribute to the record of their own support plan
- ensuring, before support is arranged, they receive and understand information about the basis for financial assessment and any charges/contributions (the DH has issued guidance to local authorities on calculating an individual’s contribution to their personal budget )
- ensuring individuals with cognitive or sensory impairment or limited capacity are given all necessary assistance, including help with communication and interpretation, to participate as fully as possible in decisions about their lives
- securing the provision of information, advice, advocacy and/or brokerage, to help them plan their own support
- ensuring that people have a written record of their assessment and their support plan
- following the Mental Capacity Act Principles when plans are being drawn up for or with individuals who lack capacity, using an Independent Mental Capacity Advocate when they are eligible.
- consider, in formulating the care plan within the council’s policies, whether the level of a carer’s contribution is such as to warrant provision of services to the carer, or extra support to the individual to relieve pressure on carers
- ensure that carers have the relevant information and advice necessary to support them within their caring roles, and that they understand the arrangements for requesting a carer’s assessment if they wish
- consider any implications for other family members (e.g. the nature and level of support provided by young carers). Caring is more complex than in the past, with more carers trying to provide support at a distance, more mutual caring between people with high levels of impairment and dependence, and more young carers
- engage and work jointly with health care professionals to ensure awareness of people’s health conditions, health care needs and NHS support
- follow legal requirements, the council’s procedures, service coordination arrangements and multi-agency agreements when an individual has been formally assessed as lacking capacity to make decisions about their care and support needs and arrangements
- ensure records of the support plan are in accessible formats and language, and:
- are person-centred and based on agreed and shared outcomes, assessments of risk and arrangements to manage them
- identify areas of disagreement or conflict about needs, risks and how to address them, together with any anticipated difficulties these might cause when carrying out the plan
- clarify resources, highlight responsibilities, identify when and how problems will be handled and set out who to contact and what to do in emergencies.
The Care Bill provides detailed accounts of the preparation and content of a care and support plan, or support plan in the case of a carer, and of a personal budget. The Bill will require the local authority to take all reasonable steps to reach agreement with the adult or carer for whom the plan is being prepared about how the authority should meet the needs in question.
The Bill also sets out a new framework for the funding of long-term care, building on the recommendations of the Dilnot Commission.  There will be new arrangements for calculating the contribution expected from individuals receiving care and support, and from carers when they are themselves provided with support services. A new scheme will enable deferral of payment of the assessed contribution to the costs of care for the lifetime of the individual. Local authorities will be required to maintain up-to-date care accounts, recording the accrued costs of the individual’s care, in order to determine when those costs reach the lifetime cap above which no further charge is applied. The Bill makes a clear distinction between costs of care, and day-to-day living costs, which remain the responsibility of the individual.