What the Care Act 2014 means for social workers

The draft statutory guidance for the Care Act 2014 provides a blueprint for how councils should implement the legislation in April 2015 and how they should deploy social workers and other staff in doing so.

Below we set out some of the key provisions for social workers and what the draft guidance has to say about their role.

Prevention

The Act places a duty on local authorities to provide or arrange services that reduce needs for support among people and their carers in the local area, and contributes towards preventing or delaying the development of such needs (section 2).

The draft statutory guidance states that preventive services should operate at three levels: primary prevention to stop care and support needs from developing among those who do not have them,, for example through health promotion or action to reduce isolation; secondary prevention, for people at increased risk of developing needs, which could involve housing adaptations or telecare that prevent deterioration; and tertiary prevention for people with established needs to help improve independence, for example through reablement.

Assessments should seek to promote independence and resilience by identifying people’s strengths and informal support networks, as well as their needs and the risks they face, and asking what a good life means to them and how they think it can be achieved in partnership with professionals.

Information and advice

Section 4 of the Act places a duty on councils to establish and maintain a service providing information and advice to local people on care and support.

The draft statutory guidance sets out what topics councils should provide – or commission – information and advice on, and specifies that they must ensure that this is accessible and open to all who would benefit from it. It also sets out a clear role for social workers in supporting staff providing information and advice so that people with more complex needs can be identified as soon as possible.

“To help ensure that information and advice is proportionate to the needs of those for whom it is provided, a local authority should enable those providing information and advice to people contacting the local authority to have access to the support of registered social work advice when it is required,” it says. “This can help ensure that the potential for complexity is recognised early on and the person receives help to access non-statutory services and/or initial statutory sector support proportionate to their needs.”

Assessment

Sections 9-13 sets out the Act’s provisions on assessing adults and carers, including duties to assess adults if they appear to have needs for care and support, and carers if they appear to have needs for support. These are fleshed out in the draft statutory guidance.

Who can do an assessment?
The guidance says assessments can be carried out by a range of professionals including registered social workers, occupational therapists, rehabilitation officers and those with relevant NVQs. It adds: “Registered social workers and occupational therapists are considered to be two of the key professions in adult care and support. Local authorities should consider how adults who need care, carers, and assessors have access to registered social care practitioners, such as social workers or occupational therapists.”

Specialist assessments and complex needs

The guidance says registered social workers are “uniquely placed to be involved in complex assessments which indicate a wide range of needs, risks and strengths that may require a co-ordinated response from a variety of statutory and community services”. They can also advise and support assessors when assessing someone who may lack capacity to carry out relevant decisions.

Assessors who do not have knowledge of a condition must consult someone with knowledge of it through training or experience. The expert can be either external or in-house. Councils must ensure an expert is involved in the assessment for adults who are deafblind.

Training of assessors

It says assessors must have suitable and up to date training, maintained throughout their career, including knowledge of the conditions they are being asked to assess such as autism, learning disabilities, mental health problems or dementia. It adds that social workers have to demonstrate their continuing professional development in order to maintain their professional registration with the Health and Care Professions Council.

Assessments by phone

Where the individual’s needs are easily recognisable the assessment can be done by phone but councils should be aware of the risks of doing so, the guidance says. For example staff should have training in recognising issues around mental capacity. Where a person may lack to carry out relevant decisions, the assessment must be carried out face-to-face.

Supporting people through the care and support planning process
Social workers may provide one-to-one support to help people develop their care plans if they wish although they may prefer to develop it themselves with their family, friends or others. The level of involvement should be agreed with the individual and anyone else they choose to involve. Social workers should talk to the person about their confidence to take a lead in the process and what support they feel they need to be meaningfully involved. Social workers may need additional skills, which councils should help them acquire, on how community-based and unpaid support can contribute to parts of the plan, such as support that builds emotional wellbeing and social connections.

If the person has substantial difficulty in being involved in the planning process and has no family or friends to support them, the local authority must commission an independent advocate to represent them and facilitate their involvement. This includes cases where the person lacks the capacity to decide to be fully involved in their care plan or consent to it.

Planning for people who lack capacity
If a councils thinks a person may lack capacity to make a decision or plan, even after being offered support, then a social worker or other suitably qualified professional needs to assess their capacity in relation to the decision being made (for example whether the person has the capacity to decide whether family members should be involved in their care planning).

Minimising and authorising deprivation of liberty for people who lack capacity

In line with the Mental Capacity Act (MCA), care and support plans must minimise planned restrictions and restraints on the person as much as possible. These planned restrictions and restraints must be documented and reported to a social worker to agree. Significant restraints and restrictions that amount to a deprivation of liberty must be authorised under the Deprivation of Liberty Safeguards (Dols). But the guidance says that in most cases a deprivation of liberty would be avoided with proper person-centred planning.
Planned reviews
During the planning process the individual and their social worker, or another professional, may have recorded a date for review of the plan. The guidance says this can help to personalise care and support and assist councils in planning their workloads. But the authority should still keep the plan under review outside these dates, the guidance says.

The first review

The first planned review should be a ‘light-touch’ look at the planning arrangements six to eight weeks after sign-off of the personal budget and plan, and should be combined with an initial review of direct payment arrangements where relevant.

Reviewing several plans simultaneously
If the care and support plan is combined with other plans that are reviewed annually, like education, health and care plans, then the council should try to conduct reviews together.
Review options including face to face and peer-led reviews
Review options could include self-review, peer-led review, reviews conducted remotely, or face-to-face reviews with a social worker. The planned review should be proportionate to the circumstances and to the value of the personal budget, the guidance says. The method of review should be agreed with the person and involve them and other people they identify where possible.

Reviews for people lacking capacity

If someone has a mental impairment and lacks capacity to make some decisions then the council should carefully consider when the next review should take place and is encouraged to make use of a social worker as the lead professional.

Reviews for people with deteriorating conditions or few family or friends supporting them

More frequent reviews may be needed for people who have a progressive condition and their health is deteriorating and for people who have few family or friends supporting them. The guidance says it may be helpful to put a duty to request a review into commissioned services for these groups. So, for example, a domiciliary care worker should be required to ask for a review if they believe the person is in need of one.
Reviews that propose increased restraints or restrictions on a person who has not got the capacity to agree them
Councils should have policies for recognising and handling revisions to support plans that propose increased restraints or restrictions on a person who has not got the capacity to agree them. These changes could become a deprivation of liberty, which requires appropriate safeguards to be in place, the guidance says. The social worker, occupational therapist or other relevant social care qualified professional or mental capacity lead should be involved, as well as an advocate.
Adult safeguarding
Professionals and staff need to be able to handle adult safeguarding enquiries – for example suspected abuse or neglect – in a sensitive and skilled way to minimise distress to the individual. The guidance says it is likely that many enquiries will require the input and supervision of a social worker, particularly in more complex situations. For example, where abuse or neglect is suspected within a family or informal relationship it says it is likely that a social worker will be the most appropriate lead.

Who can carry out an enquiry into safeguarding concerns

Councils must make enquiries whenever abuse or neglect are suspected in relation to an adult with care and support needs or ensure another agency does so. The circumstances will often determine the right person to begin an enquiry. In many cases it will be a professional who already knows the individual, such as a social worker, a housing support worker, or health worker such as a community nurse.

Assessments of young people making the transition to adult care and support

Social workers will often be the most appropriate professionals to carry out assessments of young people with complex cases who are making the transition to adult services. The guidance says transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.