Continuity of Care

1. Introduction

People with care and support needs may decide to move home just like anyone else, for example to be closer to family, for education or employment opportunities, or because they simply want to live in another area. Where they do decide to move to a new local authority area and as a result their ordinary residence status will change (see Ordinary Residence chapter), it is important to ensure that care and support is in place during the move, so the person’s wellbeing is maintained.

In circumstances where a person is receiving local authority support and moves within their current local authority (for example, moving between homes in the same area), they remain ordinarily resident within that authority and it must continue to meet their needs. Where the person chooses to live in a different local authority area, the local authority that is currently arranging care and support and the authority to which they are moving must work together to ensure that there is no interruption to the person’s care and support.

This chapter sets out the process local authorities must follow to ensure that the person’s care and support continues, without disruption, during and after the move. These procedures also apply where the person’s carer is receiving support and will continue to be required after the move. In addition to meeting their responsibilities set out in this chapter, the current local authority has other responsibilities that continue to apply during this process (see the chapters on Promoting Wellbeing, Preventing, Reducing or Delaying Needs, Information and Advice, Integration, Cooperation and Partnerships, Assessment, Eligibility and Care and Support Planning chapters).

The aim of this process is to ensure that the person with care and support needs will have confidence that arrangements to meet their needs will be in place on the day of their move. Local authorities are expected to achieve continuity of care by ensuring that the second authority has completed a needs assessment and developed a care and support plan for the individual prior to the day of the move. Where the second local authority has been unable to complete a needs assessment before the day of the move, for example due to the logistics of assessing a person a long distance away or because they want to assess the adult in their new home, it must continue to meet the needs and take into account outcomes identified in the adult’s current care and support plan until it has carried out its own assessment.

The key to ensuring that the adult’s care continues without interruption is through both local authorities working together and keeping the adult (and their carer, where relevant) at the centre of the process.

2. Making an informed decision to move to a different local authority

When thinking about the possibility of moving, an adult may want to find out information about the care and support available in one or more authorities. Local authorities may already make much of this information publicly available under its Care Act duties (see Information and Advice chapter), and they should provide any extra information requested by the adult and where relevant, their carer.

Local authorities can provide the adult and their carer with relevant information or advice to help inform their decision. When providing relevant information and advice, local authorities should guard against influence over the final decision. The authorities can, for example, provide advice on the implications for the individual’s care and support (and their carer’s support), but the final decision on whether or not to move is for the adult and, if relevant, the carer to make.

The prompt provision of this information will help the adult make an informed decision and assist the process if the adult decides that they want to move.

3. Confirming the intention to move

The continuity of care process starts when the second authority is notified of the adult’s intention to move. Local authorities may find out about the person’s intention to move from the individual directly or through someone acting on their behalf, who may contact either the first authority or the second authority to tell them of their intentions. If the person has approached the first authority and informed them of their intention to move, the first authority should make contact with the second authority to let them know that the person is planning on moving to their area.

When the person has confirmed their intention to move with the second authority, the authority must assure itself that the person’s intention is genuine. This is because the duties in the Care Act start from this point.

To assure itself that the intention is genuine, the second authority should:

• establish and maintain contact with the person and their carer to keep abreast of their intentions to move;
• continue to speak with the first authority to get their view on the person’s intentions;
• ask if the person has any information or contacts that can help to establish their intention.

When the second authority is satisfied that the person’s intentions to move are genuine, it must provide the adult (and the carer if also intending to move), with accessible information about the care and support available in its area. This should include but is not limited to, details about:

• the types of care and support available to people with similar needs, so the adult can know how they are likely to be affected by differences in the range of services available;
• support for carers;
• the local care market and organisations that could meet their needs;
• the local authority’s charging policy, including any charges which the person may be expected to meet for particular services in that area.

Where the person moving currently receives a direct payment to meet some or all of their needs, the first authority should advise the person that they will need to consider how to meet any contractual arrangements put in place for the provision of their care and support. For instance, any contracts they may have with personal assistants who may not be moving with them.

4. Supporting people to be fully involved

The person may request assistance from either the first or second authority in helping them understand the implications of their move on their care and support, and the authority should ensure that they have access to all relevant information and advice. This should include consideration of the need for an independent advocate in helping the person to weigh up their options (see Independent Advocacy chapter).

There will be situations where the adult may lack capacity to make a decision about a move, but the family wish to move the adult closer to where they live (see Mental Capacity chapter).

In such situation the local authority must first carry out supported decision making, supporting the adult to be as involved as possible and must carry out a capacity assessment and where necessary then take ‘best interests’ decisions. The requirements of the Mental Capacity Act 2005 apply to all those who may lack capacity.

5. Preparing for the move

Once the second authority has assured itself that the adult’s (and where relevant the carer’s) intentions to move are genuine, it must inform the first authority. At this stage, both authorities should identify a named staff member to lead on the case and be the ongoing contact during the move. These contacts should make themselves known to the person and lead on the sharing of information and maintaining contact on progress towards arranging the care and support for the adult and support for the carer. These contacts should be jointly responsible for facilitating continuity of care within an acceptable timeframe, taking into consideration the circumstances behind the adult’s intention to move, such as a job opportunity.

The second authority must provide the adult and carer with any relevant information that it did not supply when the person was considering whether to move.

When the first authority has been notified by the second authority that it is satisfied that the person’s intention to move is genuine, the first authority must provide it with:

• a copy of the person’s most recent care and support plan;
• a copy of the most recent support plan where the person’s carer is moving with them;
• any other information relating to the person or the carer (whether or not the carer has needs for support), that the second authority may request.

The information the second authority may request may include the most recent needs assessment if the person’s needs are not likely to change as a result of the move, the adult’s financial assessment, any safeguarding plan that have been completed for the individual, and, where a Deprivation of Liberty has been authorised for a person who is moving to a new local authority area, a new referral for a Deprivation of Liberty must be made to the new local authority.

6. People receiving Services under Children’s Legislation

The continuity of care provisions in the Care Act do not apply for people receiving services under children’s legislation. Where such a person has had a transition assessment (see Transition to Adult Care and Support chapter) but is moving area before the actual transition to adult care and support takes place, the first local authority should ensure that the second is provided with a copy of the assessment and any resulting transition plan. Similarly, where a child’s carer is having needs met by adult care and support in advance of the child turning 18 (following a transition assessment), the first local authority should ensure that the second is provided with a copy of the assessment and the carer’s support plan.

7. Assessment and Care and Support Planning

If the person has substantial difficulty and requires help to be fully involved in the assessment or care planning process and there is no other suitable person who can support them, they must be provided with an independent advocate. In this case the advocate should be provided by the second authority because it takes over the responsibility for carrying out the assessment and care planning with the individual (see Independent Advocacy chapter).

The second authority must contact the adult and the carer to carry out an assessment and to discuss how arrangements might be made. The second authority should also consider whether the person might be moving to be closer to a new carer and whether that new carer would benefit from an assessment.

Throughout the assessment process, the first authority must keep in contact with the second authority about progress being made towards arranging necessary care and support for the day of the move. The first authority must also keep the adult and the carer informed and involved of progress so that they have confidence in the process. This should include involving them in any relevant meetings about the move. Meetings may be held online / via video call where there are long distances between the local authorities involved. Having this three way contact will keep the individuals at the centre of the process, and help ensure that arrangements are in place on the day of the move.

All assessments, for adults with care and support needs and carers, must be carried out in line with the processes described in the Assessment chapter. The adult and the carer, and anyone else requested, must be involved in the respective assessments. The assessments must identify the person’s needs and the outcomes they want to achieve. These could be the same as the outcomes the first authority was meeting or they could have changed with the person’s circumstances.

The assessment must consider whether any preventative services or advice and information would help either person meet those outcomes. The assessments should also consider the individuals’ own strengths and capabilities and whether support might be available from family, friends or within the new community to achieve their outcomes. In carrying out the assessments, the second authority must take into account the previous care and support plan (or support plan) which has been provided by the first authority.

Following the assessment, and after determining whether the adult or carer has eligible needs, the second authority must involve the adult, the carer and any other individual the person requests, in the development of their care and support plan, or the carer’s support plan as relevant, and take all reasonable steps to agree the plan. The development of the care and support plan or carer’s support plan should include consideration of whether the person would like to receive a direct payment (see Care and Support Planning chapter).

The second authority should agree the adult’s care and support plan and carer’s support plan, including any personal budget, in advance of the move to ensure that arrangements are in place when the person moves into the new area. This should be shared with the individuals before the move so that they are clear how their needs will be met, and this must also set out any differences between the person’s original plan and their new care and support or support plan. Such differences could arise where the range of services in one local authority differs from the range of services in another. The second authority must also explain to the adult or carer where there are any differences in their needs.

The care and support plan should include arrangements for the entire day of the move. This should be agreed by the adult, the carers (existing and new as relevant) and both authorities. The first authority should remain responsible for meeting the care and support needs the person has in their original home and when moving. The second authority is responsible for providing care and support when the person and their carer move into the new area. The person moving is responsible for organising and paying for moving their belongings and furniture to their new home.

In considering the person’s personal budget, the second authority should take into consideration any differences between the costs of making arrangements in the second authority compared with the first authority and provide explanation for such a difference where relevant. Where there is a difference in the amount of the personal budget, this should be explained to the person. It should also look to ensure that the person’s direct payment is in place in a timely manner since, for example, the person moving may have a personal assistant that is also moving and will require payment.

8. Health and Social Care Needs

The adult and their carer may have health needs as well as care and support needs. Both local authorities should work with their local Integrated Care Boards (ICBs) to ensure that all of the adult’s and carer’s health and care needs are being dealt with in a joined-up way.

Who Pays? (NHS England) sets out the framework for establishing which NHS commissioner will be responsible for commissioning and paying for a person’s NHS care.

If the person also has health needs, the second local authority should carry out the assessment jointly with their local ICB. Alternatively, if the ICB agrees, the second authority can carry out the assessment on its behalf. Having a joint assessment ensures that all of the person’s needs are being assessed and the second authority can work together with the ICB to prepare a joint plan to meet the adult’s care and support and health needs. Where relevant, the local authority may use the cooperation procedures set out in the Care Act to require cooperation from the ICB, or other relevant partners, in supporting with the move (see Integration, Cooperation and Partnerships chapter).

Providing joint care and support and health plans will avoid duplication of processes and the need for multiple monitoring regimes. Information should be shared as quickly as possible with the minimum of bureaucracy. Local authorities should work alongside health and other professionals where plans are developed jointly to establish a ‘lead’ organisation which undertakes monitoring and assurance of the combined plan. Consideration should be given to whether a person should receive a personal budget and a personal health budget to support integration of services (see Personal Budgets chapter).

9. Equipment and Adaptations

Many people with care and support needs will also have equipment installed and adaptations made to their home. Where the first authority has provided equipment, it should move with the person to the second authority where this is the person’s preference and it is still required and doing so is the most cost effective solution. This should apply whatever the original cost of the item. In deciding whether the equipment should move with the person, the local authorities should discuss this with the individual and consider whether they still want it and whether it is suitable for their new home. Consideration will also have to be given to the contract for maintenance of the equipment and whether the equipment is due to be replaced.

As adaptations are fitted based on the person’s accommodation, it may be more practicable for the second authority to organise the installation of any adaptations. For example, walls need to be checked for the correct fixing of rails.

Where the person has a piece of equipment on long-term loan from the NHS, the second local authority should discuss this with the relevant NHS body. The parties are jointly responsible for ensuring that the person has adequate equipment when they move (see Integration, Cooperation and Partnerships chapter).

10. Copies of Documentation

The second authority must provide the adult and the carer and anyone else requested with a copy of their assessments. This must include a written explanation where it has assessed the needs as being different to those in the care and support plan or the carer’s support plan provided by the first authority. The second authority must also provide a written explanation if the adult’s or carer’s personal budget is different to that provided by the first authority.

11. Where the Second Authority has not carried out an Assessment before the Day of the Move

The second local authority is generally expected to have carried out their needs assessment of the persons moving prior to the day of the move. However, there may be occasions where the authority has not carried out the assessments or has completed the assessments but has not made arrangements to have support in place. This might happen where the second authority wants to assess the person in their new home and consider if their needs have changed, for example because they have started a new job or are now in education, or they have moved to be closer to family. The second authority must still have made contact with the adult and their carer in advance of the move.

Where the full assessment has not taken place prior to the move, the second authority must put in place arrangements that meet the adult’s or carer’s needs for care and support as identified by the first authority. These arrangements must be in place on the day of the move and continue until the second authority has carried out its own assessment and put in place a care and support plan which has been developed with the person.

The second authority must involve the adult and carer, and any relevant independent advocate, as well as any other individual that either person may request, when deciding how to meet the care and support needs in the interim period. The authority must take all reasonable steps to agree these temporary arrangements with the relevant person.

12. Matters the Second Local Authority must Consider when making Arrangements

The Care and Support (Continuity of Care) Regulations 2014 require the second authority to have regard to the following matters when meeting the person’s needs in advance of carrying out their own assessment:

12.1 Care and support plan

The adult’s care and support plan, and the carer’s support plan if the carer is also moving, which were provided by the first authority. The second authority should discuss with the adult and the carer how to meet their eligible needs and any other needs that the first authority was meeting that are not deemed as eligible but were included in either plan.

12.2 Outcomes

Whether the outcomes that the adult and the carer were achieving in day-to-day life in their first authority are the outcomes they want to achieve in the new authority, or whether their aims have changed because of the move.

12.3 Preferences and views

The preferences and views of the adult and the carer on how their needs are met during the interim period.

The second authority must also consider any significant difference to the person’s circumstances where that change may impact on the individual’s wellbeing, including:

12.4 Support from a carer

Whether the adult is currently receiving support from a carer and whether that carer is also moving with them. Where the carer is not also moving, the second authority must consider how to meet any needs previously met by the carer, even if the first authority was not providing any service in relation to those needs.

12.5 Suitability of accommodation

Where the new accommodation is significantly different from the original accommodation and this changes the response needed to meet the person’s needs. For example, the adult may move from a ground floor flat to a first floor flat and now need assistance to manage stairs.

Where the person has received equipment or had adaptations installed in their original home by the first authority, see Section 9, Equipment and Adaptations.

12.6 Access to services and facilities

Where the services and facilities in the new area are different, and in particular fewer than those in the originating area; for example access to food deliveries or other food outlets, access to public transport, or access to leisure or recreational facilities, the person’s workplace. A move from an urban to a rural environment could bring this about.

12.7 Access to other types of support

Where the person was receiving support from friends, neighbours or the wider community and this may not readily be available in their new area. For example, where the person makes use of universal services such as local authority day services, drop in support, or befriending schemes, and these are not available in the new area

If the person has substantial difficulty in being fully involved in the assessment, care planning or review process the second authority should consider whether the person needs an independent advocate or whether their original advocate is moving with them (see Independent Advocacy chapter).

The second authority should ascertain this information from relevant documentation sent to them or by talking to the individuals involved, and the first authority.

The adult or carer should not be on an interim care and support (or support) package for a prolonged period of time as a tailored care and support (or support) plan must be put in place. The second authority should carry out the assessment in a timely manner.

13. When the Adult does not move or the move is Delayed

There are a range of reasons why a person might not move on the designated day. This may be, for example, because they have become unwell or there is a delay in exchanging contracts as part of a house sale. Where there has been a delay because of unforeseen circumstances, both authorities should maintain contact with the person to ensure that arrangements are in place for the new date of the move.

If the person’s move is delayed and they remain resident in the area of the first authority, they will normally continue to be ordinarily resident in that area and so the first authority will remain responsible for meeting the person’s and the carer’s needs. Both local authorities may have incurred some expense in putting arrangements in place before the move was delayed. In such circumstances each of the authorities should consider agreeing to cutting their losses incurred in preparing continuity of care.

In circumstances where the second authority has not assessed the person prior to the move and is planning to meet needs based on their original care and support plan, but it transpires that the individual does not move to the second authority (and so the first authority remains responsible for providing care and support), the Care Act does provide for the second authority to be able to recover any costs it incurred from the first authority. In deciding whether to recover these costs the second authority may want to consider, for example, whether the first authority was aware that the person was not going to move and had not told the second authority or whether the first authority was not aware and was unable to advise the second authority not to make arrangements. The second authority should consider whether it would be reasonable to recover their costs depending on the circumstances of the case.

14. Disputes about Ordinary Residence and Continuity of Care

Where local authorities are in dispute over application of the continuity of care provisions, the authorities who are parties to the dispute must not allow their dispute to prevent, delay or adversely affect the meeting of the person’s needs. Where the authorities cannot resolve their differences, steps must be taken to ensure that the person is unaffected by the dispute and will continue to receive care for the needs that were identified by the first local authority (see Ordinary Residence chapter).

15. Making complaints

It is important that individuals have confidence in the assessment process and the wider care and support system. Therefore any individual should be able to make a complaint and challenge decisions where they believe a wrong decision has been made in their case. Anyone who is dissatisfied with a decision made by the local authority can make a complaint about that decision and have that complaint handled by the local authority (see Complaints chapter).

16. Further Reading

16.1 Relevant chapters

Preventing, Reducing or Delaying Needs

Assessment

Eligibility

16.2 Relevant information

Chapter 20, Continuity of Care, Care and Support Statutory Guidance (Department of Health and Social Care)

Quality Statement 3: Continuity of Care and Support (NICE)

Chapter 20, Continuity of Care, Care and Support Statutory Guidance (Department of Health and Social Care)

Quality Statement 3: Continuity of Care and Support (NICE)