CQC Quality Statements

Theme 2 – Providing Support: Care Provision, integration and continuity

We statement

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

What people expect

I have care and support that is co-ordinated, and everyone works well together and with me.

1. Introduction

The possibility of interruptions to care and support services causes uncertainty and anxiety for people receiving services, their carers, family and friends. Interruptions can arise for a number of different reasons, for example when a provider of services faces commercial difficulties that puts the continuation of their business under threat. Both large national and small local providers can experience commercial issues which cause uncertainty for people receiving care and support. The local authority has an important role in situations where a provider is unable to continue to supply services because of business failure.

There are numerous other situations that can cause disruption to care and support services. Some may impact on the whole business – for example a provider decides to close the business down, while others impact on a particular service – for example an outbreak of COVID 19 or other infectious disease at a care home or staff shortages. The local authority should use their powers to act in such cases, as set out below.

Planning to reduce the likelihood of possible disruption is important, and local authorities should work with care providers to support them to regularly review and update their business continuity plans.

2. Definitions

2.1 Business failure

‘Business failure’ is defined in the Care and Support (Business Failure) Regulations 2015. It is defined by a list of different events such as:

  • the appointment of an administrator;
  • the appointment of a receiver or an administrative receiver (the full list appears in the Regulations).

Service interruption because of business failure relates to the whole of the regulated activity and not to parts of it.

2.2 Temporary duty

‘Temporary duty’ or ‘duty’ means the duty on the local authority to meet needs in the case of business failure. ‘Temporary’ means the duty continues for as long as the local authority considers it necessary. The temporary duty applies regardless of whether a person is ordinarily resident in the authority’s area (see Ordinary Residence chapter).

It applies from the moment the authority becomes aware of the business failure. The actions to be taken by the local authority will depend on the circumstances, and may include the provision of information. The duty is to meet needs but the local authority has discretion as to how it meet those needs.

3. Service Interruptions because of Business Failure

Business failure of a major provider is a rare and extreme event and does not automatically equate to closure of a service. It may have no impact on residents or the people who use the services. However, if a provider is unable to continue because of business failure, the duties on the local authority are as follows.

3.1 Temporary duty

The local authority is under a temporary duty to meet people’s needs when a provider is unable to continue to carry on the relevant activity in question because of business failure. The duty applies when a service can no longer be provided and the reason for that is that the provider’s business has failed.

If the provider’s business has failed but the service continues to be provided the duty is not triggered. This often may happen in insolvency situations where an Administrator is appointed and continues to run the service.

The duty applies where a failed provider was meeting needs in the local authority’s area. It does not matter whether or not the local authority has contracts with that provider. It does not matter if all the people affected are self-funders.

The duty is in respect of people receiving care by that provider in that authority’s area – it does not matter which local authority (if any) made the arrangements to provide services.

3.2 Meeting needs

The needs that must be met are those that were being met by the provider immediately before the provider became unable to carry on the activity. The local authority must ensure the needs are met but how that is done is for the local authority to decide, and there is significant flexibility in the Care Act 2014 in determining how to do so. It is not necessary to meet those needs through exactly the same combination of services that were previously supplied.

When deciding how needs will be met, the local authority must:

  • involve the adult concerned, any carer that the person has, or anyone whom the person asks the authority to involve (see Care and Support Planning chapter);
  • where the adult lacks capacity to ask the authority to do that, the local authority must involve anyone who appears to the local authority to be interested in their welfare;
  • where a carer’s service is involved, the local authority must involve the carer and anyone the carer asks the authority to involve.

The authority must take all reasonable steps to agree how needs should be met with the adult concerned. It should seek to minimise disruption for people receiving care, in line with the wellbeing principle (see Promoting Wellbeing chapter) and, although authorities have discretion about how to meet needs, the aim should be to provide a service as similar as possible to the previous one.

An authority has the power, where it considers it necessary, to discharge the temporary duty, to request that the provider, or anyone involved in the provider’s business as it thinks appropriate, to supply it with the information it needs. This may involve, for example, up to date records of the people who are receiving services from that provider, to help the local authority to identify those who may require its support.

The authority should act promptly to meet people’s needs. The lack of a needs assessment or carer’s assessment (see Assessment chapter) or a financial assessment (see Charging and Financial Assessment chapter) for a person must not be a barrier to action. Neither is it necessary to complete those assessments before or whilst taking action.

The local authority must meet needs irrespective of whether those needs would meet the eligibility criteria.

All people receiving services in the local authority’s area should be treated the same. In particular, how someone pays for the costs of meeting their needs – for example, in full by the adult themselves – must have no influence on whether the authority fulfils the duty.

3.3 Charging

However, an authority may charge the adult for the costs of meeting their needs, and it may also charge another local authority which was previously meeting those needs, if it temporarily meets the needs of an adult who is not ordinarily resident in its area (see Ordinary Residence chapter).  The charge must cover only the actual cost incurred by the authority in meeting the needs. No charge must be made for the provision of information and advice to the person.

3.4 Restrictions: NHS services

The Care Act imposes certain restrictions on the provision of health services by the local authority and these apply to meeting needs in provider failure cases. A local authority may not meet needs in provider failure cases by, for example, providing NHS Continuing Healthcare (see NHS Continuing Healthcare chapter). Where the failed provider’s clientèle consists of persons in receipt of NHS CHC, unless their needs appear to have changed, it would be reasonable for the local authority to conclude that it was not necessary to do anything to meet those needs. This is because the duty to provide NHS CHC falls on the NHS and local authorities cannot provide it. The duties of the NHS in such situations are covered elsewhere and as such are beyond the scope of this guidance. Authorities should refer to the Standing Rules (the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, as amended); and to the National Framework for NHS Continuing Healthcare and NHS-funded nursing care and NHS-funded Nursing Care Best Practice Guidance for further guidance.

3.5 Cooperation

In fulfilling this function, the local authority must follow the general duties to cooperate (see Integration, Cooperation and Partnerships chapter). Where an adult is not ordinarily resident in an authority’s area, that authority must cooperate with the authority which was arranging for the needs to be met previously (before the business failure). The duty of cooperation applies equally where the needs being met previously were paid for (in full or in part) by another authority through a direct payment to the person concerned.

Authorities that disagree on whether and / or how the law applies in these circumstances may apply to the Secretary of State for a determination of a dispute under the procedure that applies to disputes over ordinary residence or continuity of care (see Ordinary Residence chapter and Continuity of Care chapter).

All of the duties on the local authority described above apply equally if the needs the authority must meet were, at the time the provider became unable to carry on because of business failure, being met under arrangements made by the local authority in Wales, Scotland or Northern Ireland under the legislation that applies in those countries. An English local authority may recover from its counterparts in Wales, Scotland and Northern Ireland the costs incurred in meeting the adult’s needs. If applicable, English authorities can also recover costs from the person themselves (other than the costs of needs being met or funded by the authorities mentioned above).

Disputes between authorities in England, Wales, Scotland or Northern Ireland about whether or how the temporary duty applies in cross border situations are to be resolved under the legislation governing disputes about cross border placements (see Cross Border Placement chapter).

4. Business Failure involving a Provider in the Care Quality Commission Oversight Regime

4.1 Financial health

In April 2015, the financial ‘health’ of certain care and support providers became subject to monitoring by the CQC. The Care and Support (Market Oversight Criteria) Regulations 2015 set out the entry criteria for a provider to fall within the regime. These are intended to be providers which, because of their size, geographic concentration or other factors, would be difficult for one or more the local authority to replace, and therefore where national oversight is required. The CQC determines which providers satisfy the criteria using data available to it and it will notify the providers which meet the entry criteria.

The CQC will then assess the financial sustainability of the provider’s business. If it assesses there is a significant risk to the financial sustainability of the provider’s business, there are certain actions the CQC may take with that provider (none of which involve the local authority).

4.2 Local authority duty

Where the CQC is satisfied that a provider in the regime is likely to become unable to continue with their activity because of business failure, it is required to tell the local authority which it thinks will be required to carry out the temporary duty, so that it can prepare for the local consequences of the business failure.

The CQC will inform the local authority once it is satisfied the provider is unlikely to be able to carry on because of business failure.

The CQC’s trigger to contact the local authority is that it believes the whole of the regulated activity in respect of which the provider is registered is likely to fail, not parts of it.

It is not required to make contact with authorities if, for example, a single home owned by the provider in the regime is likely to fail because it is unprofitable and the CQC is not satisfied that this will lead to the whole of the provider’s relevant regulated activity becoming unable to continue.

In these circumstances, it is the provider’s responsibility to wind down and close the service in line with its contractual obligations and it is expected that providers would do so in a planned way that does not interrupt people’s care.

4.3 Information

Where the CQC considers it necessary to do so to help a local authority to carry out the temporary duty, it may request the provider to supply it with information and CQC must then give the information, and any further relevant information it holds, to the local authority affected. If the CQC is of the view that a provider is likely to become unable to continue with its activity because of business failure, the CQC should work closely together with the affected local authorities to help them fulfil their temporary duty. In exercising its market oversight functions, CQC must have regard to the need to minimise the burdens it imposes on others.

5. Business Failure involving a Provider not in the Care Quality Commission Oversight Regime

5.1 Local authority responsibility

Regulations set out the criteria for the CQC regime. The CQC will apply those regulations and decide which providers are included. The providers outside the regime will in the main be those with small and medium size businesses.

The temporary duty on the local authority to meet needs in the case of business failure applies regardless of whether the provider is in the market oversight regime.

Despite the CQC having a market oversight responsibility, the local authority has responsibility to ensure continuity of care in respect of business failure of all registered providers.

6. Administration and other Insolvency Procedures

Business failure will usually involve an official being appointed, for example an administrator, to oversee the insolvency proceedings. An administrator represents the interests of the creditors of the provider that has failed and will try to rescue the company as a going concern.

In these circumstances, the service will usually continue to be provided, and the exercise of the local authority’s temporary duties may not be called for.

It is not for the local authority to become involved in the commercial aspects of the insolvency, but it should cooperate with the administrator if requested.

The local authority should, insofar as it does not adversely affect people’s safety and wellbeing, support efforts to maintain service provision by, for example, not prematurely withdrawing people from the service that is affected, or ceasing to commission that service.

7. Service Interruptions other than Business Failure

7.1 Urgent needs

A local authority must meet a person’s eligible needs. This duty applies whether or not business failure is at issue. The Care Act covers the circumstances where care and support needs may be met, that is circumstances where no duties arise, but the local authority may nevertheless meet an adult’s needs.

In particular, it permits a local authority to meet needs which appear to it to be urgent. In this context, ‘urgent’ takes its everyday meaning, subject to interpretation by the courts, and may be related to, for example, time, severity etc. This is likely to be the case in many situations where services are interrupted but business failure is not the cause.

The Care Act provides powers  which can be exercised in order to meet urgent needs without having first conducted a needs assessment, financial assessment or eligibility criteria determination.

The local authority may meet urgent needs regardless of whether the adult is ordinarily resident in its area. This means it can act quickly if circumstances warrant.

The power to meet urgent needs is not limited to services delivered by particular providers and is therefore available where urgent needs arise as a result of service failure of an unregistered provider (that is a provider of an unregulated social care activity). The power may also be used in the context of quality failings of providers if that is causing people to have urgent needs.

The Care Act gives the local authority a power to act to meet needs, but it does not require that authorities must act. Whether or not to act is a decision for the authority itself but authorities should consider the examples which follow.

7.2 Power to act by the local authority

In relation to service interruption, circumstances that might lead to the exercise of the power include where the continued provision of care and support to those receiving services is in imminent jeopardy and there is no likelihood of returning to a ‘business as usual’ situation in the immediate future, leading to urgent needs.

Not all situations where a service has been interrupted or closed will merit local authority involvement because not all cases will result in adults having urgent needs. For example, if a care home closes and residents have agreed to the provider’s plans to move the residents to a nearby care home that the provider also owns, the local authority will not necessarily have to become actively involved as urgent needs might not arise. On the other hand, the local authority might wish to be satisfied that the alternative home can adequately meet the urgent needs.

Whether to act under this power is a judgement for the local authority to make in the first instance.

7.3 Provider responsibility

If a provider has not failed, it is primarily the provider’s responsibility to meet the needs of individuals receiving care in accordance with its contractual liabilities. The local authority may wish to be involved to help with this. The power provides an ultimate backstop for use where the provider cannot or will not meet its responsibilities, and where the authority judges that the needs of individuals are urgent (and where the local authority is not already under a duty to meet the adult’s needs).

7.4 Service closure: Short and long term

A service closure may be temporary (for example unforeseen absence of qualified staff, an outbreak of an infectious disease or recruitment issues) or permanent (for example, the home is to be sold on for use as a hotel). Similarly, an emergency closure or planned closure may be involved. What matters in deciding whether to meet needs is whether the needs of the people affected appear to be urgent. For example, the sale of a provider’s business may be a positive development for residents, service users and commissioners alike and may not lead to urgent needs. These powers are not intended to inhibit the effective operation of a market in improving choice, quality and investment.

Where the local authority does get involved in ensuring needs continue to be met, that involvement might be short-lived or enduring over some months. Acts of God (for example flooding) or complications with suppliers should not in themselves automatically be considered to trigger the use of the power. In all cases, the test is whether the local authority considers there is an urgent need to be met.

When considering action in relation to service interruption or closure, there is a balance to be struck. On the one hand, if the local authority knows there is a serious risk to the continued provision of a service, it may consider not using that service temporarily or reassigning people using that service to an alternative service. On the other hand, it may be possible and justifiable for the local authority to act in a way that maximises the provider’s chances of continuing to provide the service and avoiding a business failure. The local authority should weigh the consequences of its actions before deciding how to respond, in particular, how its actions might impact on the likelihood of the service continuing. Certain actions may increase the risk of precipitating the business failure.

8. Market Shaping and Market Intelligence

The Care Act sets out the local authority’s duty to promote the efficient and effective operation of the local market in care and support services (see Market Shaping and Commissioning of Adult Care and Support chapter).

Central to this function is the need to ensure that the authority has, and makes available, information about the providers of care and support services in its area and the types of services they provide. This gathering of market intelligence is equally relevant to the authority’s response to business failure and other service interruptions.

Where alternative services are to be put in place, an effective response requires a thorough knowledge of the market, which providers offer which services, the quality of each provider’s services and where there is spare capacity in service provision. In anticipating potential service interruptions, there is also a need to know the vulnerabilities in the operation of the market. Service interruptions involving such providers are likely to be more difficult to address. The local authority should have knowledge of market vulnerabilities, market capacity and capabilities such as this in order to respond effectively to service interruptions.

The local authority should understand how providers in their area are coping with the current trading conditions and regulations through discussions with the providers themselves. Authorities can achieve this without the collection of detailed financial metrics, accounts and business plans that the CQC might utilise in respect of the major corporate providers in the regime. The business failure of providers outside the CQC regime will be on a smaller scale, usually with lesser impact, and the local authority should take a proportionate approach to anticipating or getting early warning of business failure.

Local authorities may find the Cordis Bright guidance and toolkit: Assessing care market and provider sustainability helpful in developing a proportionate approach. Given that CQC is responsible for monitoring the financial sustainability of providers falling within the market oversight scheme, it is not necessary for authorities also to ask for detailed financial information from these providers.

9. Business Continuity Plans and Contingency Planning

9.1 Business continuity plans

Local authorities should work with care homes and support them to review their business continuity plans. Plans may need to be strengthened (for example in relation to any potential staffing issues or managing an outbreak of COVID-19.) In addition, local authorities should be reviewing their own continuity plans so they reflect the potential impact on services locally and identify ways to respond.

Whilst there is no longer a requirement for staff or visitors to be double vaccinated against COVID-19 (unless they are exempt), local authorities should support providers in encouraging staff to receive all recommended vaccinations.

9.2 Other local authorities

Most service interruptions are on a small scale and are easily managed, however service interruptions on a large scale pose far greater problems. If a provider which operates nationwide fails, the local authority is less likely to be able to respond effectively on its own. It should consider how it would respond to different service interruptions and, where the involvement of neighbouring authority / authorities would be essential in order to maintain services, ensure effective liaison and information sharing arrangements are set up in advance.

Close cooperation between authorities may be particularly required where an authority has a substantial number of people placed within its area by other authorities.

9.3 Other providers

As part of contingency planning, the authority should discuss with local providers which services it would be willing and able to provide if the need arose because another local provider had failed. This should help to facilitate a prompt response that would help to maintain continuity of care for the people affected. Through its market shaping activities, the authority should encourage trust between the parties so that effective relationships exist where urgent needs are to be met.

9.3 Media

Service interruptions are often the cause of much anxiety and media attention. The local authority should have the capacity to react quickly to any media reporting of service interruptions, whether large scale or small, if uncertainty and anxiety are to be minimised.

9.5Risk assessment

It should consider how to undertake contingency planning most effectively at a local level, to ensure preparedness for possible service interruptions in the future. Service interruptions are often unforeseen and require rapid response. The local authority should review which service interruptions pose the greatest risk in their locality and consider developing contingency plans in advance, in conjunction with local partners. This may include regional activity with other the local authority in the same area, where risks are better shared between a number of neighbouring authorities.

The local authority already plans and manages challenging situations as a matter of course, for example, school closures from public health outbreaks or the impact of extreme weather. Contingency planning for social care should sit alongside the authority’s other emergency planning activities.

Local authorities may find it useful to consider the Local Government Information Unit guide, Care and continuity: contingency planning for provider failure.

10. Further Reading

10.1 Relevant chapter

Market Shaping and Commissioning of Adult Services

10.2 Relevant information

Chapter 5, Managing Provider Failure and other Service Interruptions, Care and Support Statutory Guidance

Social Care Provider Resilience during Covid-19: Guidance for Commissioners (ADASS, LGA and CPA)

Managing Care Home Closures: A Good Practice Guide for Local Authorities, Clinical Commissioning Groups, NHS England, Care Quality Commission, Providers and Partners (NHS England et al)

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CQC Quality Statements

Theme 2 – Providing Support: Care Provision, integration and continuity

We statement

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

What people expect

I have care and support that is co-ordinated, and everyone works well together and with me.

1. Introduction

High quality, personalised care and support can only be achieved where there is a vibrant, responsive market of service providers. The role of the local authority is critical to achieving this, both through the actions it takes to commission services directly to meet needs and the broader understanding of and interactions it undertakes with the wider market, for the benefit of all local people and communities.

The Care Act 2014 places duties on local authorities to promote the efficient and effective operation of the market for adult care and support as a whole. This can be considered a duty to facilitate the market, in the sense of using a wide range of approaches to encourage and shape it, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost effective outcomes that promote the wellbeing of people who need care and support.

The market for care and support services is part of a wider system in which much of the need for care and support is met by people’s own efforts, by their families, friends or other carers, and by community networks. Local authorities have a vital role in ensuring that universal services are available to the whole population and where necessary, tailored to meet the needs of those with additional support requirements (for example housing and leisure services). Market shaping and commissioning should aim to promote a market for care and support that should be seen as broadening, supplementing and supporting all these vital sources of care and support.

Local authorities should review the way they commission services, as this is a prime way to achieve effective market shaping and directly affects services for those whose needs are met by the local authority, including where funded wholly or partly by the state.

At a time of increasing pressure on public funds, changing patterns of needs, and increasing aspirations of citizens, together with momentum for integrated services, joint commissioning, and choice for individuals, changes to the way care and support services are arranged are needed, driven through a transformation of the way services are led, considered and arranged. Commissioning and market shaping are key levers for local authorities in designing and facilitating a healthy market of quality services.

2. Definitions

2.1 Market shaping

Market shaping means the local authority collaborating closely with other relevant partners, including people with care and support needs, carers and families, to facilitate the whole market in its area for care, support and related services.

This includes:

  • services arranged and paid for by the state through the authority itself;
  • those services paid by the state through direct payments;
  • those services arranged and paid for by individuals from whatever sources (self-funders);
  • services paid for by a combination of these sources.

Market shaping activity should stimulate a diverse range of appropriate high quality services (both in terms of the types, volumes and quality of services and the types of provider organisation), and ensure the market as a whole remains vibrant and sustainable.

The core activities of market shaping are to engage with stakeholders to develop an understanding of supply and demand to understand likely trends that reflect people’s needs and aspirations. It should be based on evidence, to signal to the market the types of services needed now and in the future to meet them, encourage innovation, investment and continuous improvement.

It includes working to ensure that those who purchase their own services are empowered to be effective consumers, for example by helping people who want to take direct payments make informed decisions about employing personal assistants. A local authority’s own commissioning practices are likely to have a significant influence on the market to achieve the desired outcomes, but other interventions may be needed, for example, incentivising innovation by user-led or third sector providers, possibly through grant funding.

2.2 Commissioning

Commissioning is the local authority’s cyclical activity to assess the needs of its local population for care and support services, determining what element of this needs to be arranged by the authority, then designing, delivering, monitoring and evaluating those services to ensure appropriate outcomes. Commissioning has come to be shaped more by the outcomes commissioners and individuals identify, rather than volumes of activity expected and commissioners have sought to facilitate flexible arrangements with providers for other forms of service to support choice and control, such as Individual Service Funds (ISFs).

2.3 Procurement

Procurement is the specific function carried out by the local authority to buy or acquire the services it has a duty to arrange in order to meet people’s needs, to agreed standards to provide value for money to the public purse and deliver its commissioning strategy.

2.4 Contracting

Contracting is the means by which that process is made legally binding. Contract management is the process that ensures that the services continue to be delivered to the agreed quality standards. Commissioning encompasses procurement but includes the wider set of strategic activities.

Market shaping, commissioning, procurement and contracting are inter-related activities and the themes of the Care and Support Statutory Guidance apply to each to a greater or lesser extent depending on the specific activity.

3. Principles of Market Shaping and Commissioning

3.1 Focusing on outcomes

The local authority must ensure the promotion of the wellbeing of individuals who need care and support, and the wellbeing of carers. The outcomes they require, are central to all care and support functions in relation to individuals, emphasising the importance of enabling people to stay independent for as long as possible. See Promoting Wellbeing chapter and Preventing, Reducing and Delaying Needs chapter.

The local authority will need to understand the outcomes which matter most to people in its area, and demonstrate that these outcomes are at the heart of its local strategies and approaches.

The local authority should consider the Adult Social Care Outcomes Framework (ASCOF) in addition to any locally collected information on outcomes and experiences, when framing outcomes for its locality and groups of people with care and support needs (see also Outcomes in Adult Social Care chapter). The local authority should have regard to guidance from the Think Local Act Personal (TLAP) Partnership when framing outcomes for individuals, groups and their local population. In particular Making It Real which sets out what good personalised care and support should look like from the perspective of people with care and support needs, carers and family members.

Outcomes should be considered both in terms of outcomes for individuals and outcomes for groups of people and populations. Local authorities should consider the Care Quality Commission standards for quality and any emerging national frameworks for defining outcomes.

Local authorities should consider analysing and presenting local needs for services in terms of outcomes required. Local authorities should ensure that achieving better outcomes is central to its commissioning strategy and practices, and should be able to demonstrate that they are moving to contracting in a way that is outcomes based. Local authorities should consider emerging best practice on outcomes based commissioning.

Outcomes based services are service arrangements that are defined on the basis of an agreed set of outcomes; either for an individual or a group of people. Moving more to an outcomes-based approach therefore means changing the way services are bought: from units of provision to meet a specified need (for example, hours of care provided) to what is required to ensure specified measurable outcomes for people are met.

The approach should emphasise:

  • prevention;
  • enablement;
  • ways of reducing loneliness and social isolation;
  • promotion of independence as ways of achieving and exceeding desired outcomes;
  • choice in how people’s needs are met.

Moving to an outcomes based approach will need to recognise that some outcomes are challenging to assess and local authorities may wish to consider involving service providers when considering how service evaluations can be interpreted.

In encouraging outcomes based services, consideration should be given to how services are paid for. The local authority should consider incorporating elements of ‘payments by outcomes’ mechanisms, where practical, to emphasise and embed this commissioning approach which is based on specifying the outcomes to be achieved, rather than the service outputs to be delivered. Whilst payments by outcomes may be theoretically the most appropriate approach for outcomes based services, it is recognised that proxies for outcomes may be required to make the approach practical. For example, an authority may wish to measure someone’s personal outcome ‘I want to maintain a nutritious and balanced diet’, but a proxy measure that is observable, attributable and capable of being described, could be the person receiving help with meal preparation at agreed and specified times. Care logs documenting punctual assistance in meal preparation, in conjunction with positive feedback from the person receiving care about support received might be used as part of the basis of payment.  It is also recognised that whilst these mechanisms are more commonplace in other types of commissioning, they are in their infancy for adult social care.

The design of any mechanism should, however, be introduced in cooperation with stakeholders and partners to ensure it is sustainable and ensure that innovation, and individual choice and control are not undermined. Any move to payments by outcomes should be achieved such that smaller, specialist, voluntary sector and community-based providers are not excluded from markets or disadvantaged, because for example, they do not have appropriate IT systems.

The local authority should keep under review emerging ideas and best practice about outcomes based commissioning and payments by outcomes.

The Care Act outlines the role of local authorities in preventing, reducing or delaying the need for care and support. This includes how the authority facilitates and commissions services and how it works with other local organisations to build community capital and make the most of the skills and resources already available in the area. Local authorities should consider working not just with traditional public sector partners like health, but also with a range of other partners to engage with communities to understand how to prevent problems from arising.

3.2 Promoting quality

The local authority must facilitate markets that offer a diverse range of high quality and appropriate services. In doing so, they must have regard to ensuring the continuous improvement of those services and encouraging a workforce which effectively underpins the market through:

The quality of services provided and the workforce providing them can have a significant effect on the wellbeing of people receiving care and support, and that of carers, and it is important to establish agreed understandable and clear criteria for quality and to ensure they are met (see also Promoting Wellbeing chapter).

When considering the quality of services, the local authority should be mindful of:

  • capacity;
  • capability;
  • timeliness;
  • continuity;
  • reliability;
  • flexibility;
  • wellbeing,

Where appropriate, using the definitions that underpin the CQC’s Fundamental Standards of Care as a minimum, and having regard to the ASCOF framework of population outcomes.

High quality services should enable people who need care and support, and carers, to meet appropriate personal outcome measures, for example, a domiciliary care service which provides care two days a week so that a carer who normally provides care can go to work, is not a quality service if it is not available on the specified days, or the care workers do not arrive in time to allow the carer to get to work on time.

Local authorities should also consider other relevant national standards including those that are aspirational, for example, any developed by the National Institute of Health and Care Excellence (NICE).

It should encourage a wide range of service provision to ensure that people have a choice of appropriate services; appropriateness is a fundamental part of quality. Appropriate services will meet people’s needs and reasonable preferences.

When arranging services itself, the local authority must ensure its commissioning practices and the services delivered on its behalf comply with the requirements of the Equality Act 2010, and do not discriminate against people with protected characteristics; this should include monitoring delivery against the requirements of that Act. When shaping markets for services, it should work to ensure compliance with this Act for services provided in their area that it does not arrange or pay for. Local authorities should consider care and support services for their appropriateness for people from different communities, cultures and beliefs.

The local authority should encourage services that respond to the fluctuations and changes in people’s care and support needs, for example someone with fluctuating mobility or visual impairment. It should support the transition of services throughout the stages of people with care and support needs’ lives to ensure the services provided remain appropriate. This is particularly important, for example, for young people with care and support needs and young carers transitioning to adulthood (see Transition to Adult Care and Support chapter).

The local authority should commission services having regard to the cost-effectiveness and value for money that the services offer for public funds.

People working in the care sector play a central role in providing high quality services. The local authority must consider how to help foster, enhance and appropriately incentivise this vital workforce to underpin effective, high quality services. In particular, it should consider how to encourage training and development for the workforce, including for the management of care services, though, for example, national standards recommended by Skills for Care:

and have regard to funding available through grants to support the training of care workers in the independent sector.

The local authority should consider encouraging the training and development of care worker staff to at least the standard of the Care Certificate being developed by Skills for Care and Skills for Health.

When commissioning services, the local authority should assure itself and have evidence that service providers employ staff who are remunerated to a level that enables them to retain an effective workforce. Remuneration must be at least sufficient to comply with the national minimum wage legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments. Guidance on these issues can be found at the HMRC website.

When commissioning services, the local authority should assure itself and have evidence that contract terms, conditions and fee levels for care and support services are appropriate to provide the delivery of the agreed care packages with agreed quality of care. This should support and promote the wellbeing of people who receive care and support, and allow for the service provider to meet statutory obligations to pay at least the national minimum wage and provide effective training and development of staff and enable retention of staff. It should also allow retention of staff commensurate with delivering services to the agreed quality, and encourage innovation and improvement. Local authorities should have regard to guidance on minimum fee levels necessary to provide this assurance, taking account of the local economic environment. This assurance should understand that reasonable fee levels allow for a reasonable rate of return by independent providers that is sufficient to allow the overall pool of efficient providers to remain sustainable in the long term.

As commissioners of services and providers of local public health functions, local authorities have an important role to play as a source of advice to care homes on infection control. Whilst there is no longer a requirement for staff or visitors to be double vaccinated against COVID-19 (unless they were exempt), local authorities should support providers in encouraging staff to receive all recommended vaccinations.

The local authority should also ensure that it has functions and systems in place to fulfil its duties on market shaping and commissioning itself that are fit for purpose, with sufficient capacity and capability of trained and qualified staff to meet the requirements set out in the Care Act 2014 and the Care and Support Statutory Guidance.

In particular, local authorities should encourage relevant staff to be trained or developed to meet the National Skills Academy standards and programmes of training for care and support commissioners and appropriate standards for commissioning related services such as housing services, where appropriate. Local authorities should consider the skills and capabilities needed to support new approaches to commissioning, for example, outcomes-based and integrated commissioning. Local authorities should have regard to the skill levels and qualifications for commissioning staff from Skills for Care.

3.3 Supporting sustainability

The local authority must work to develop markets for care and support that – whilst recognising that individual providers may exit the market from time to time – ensure the overall provision of services remains healthy in terms of the sufficiency of adequate provision of high quality care and support needed to meet expected needs. This will ensure there are a range of appropriate and high quality providers and services from which people can choose.

The local authority should understand the business environment of providers offering services in its area and seek to work with those facing challenges and understand their risks. Where needed, based on expected trends, the local authority should consider encouraging service providers to adjust the extent and types of service provision. This could include signalling to the market as a whole the likely need to extend or expand services, encourage new entrants to the market in the area, or if appropriate, signal likely decrease in needs – for example, drawing attention to a possible reduction in home care needs, and changes in demand resulting from increasing uptake of direct payments. The process of developing and articulating a Market Position Statement or equivalent should be central to this process.

The local authority should consider the impact of its own activities on the market as a whole, in particular the potential impact of its commissioning and re-commissioning decisions, how services are packaged or combined for tendering, and where they may also be a supplier of care and support. The local authority may be the most significant purchaser of care and support in an area, and therefore its approach to commissioning will have an impact beyond those services which it contracts. It must not undertake any actions which may threaten the sustainability of the local market as a whole, for example, by setting fee levels below an amount which is not sustainable for providers in the long term.

The local authority should have effective communications and relationships with providers in its area that should minimise risks of unexpected closures and failures. It should have effective interaction and communication with the Care Quality Commission (CQC) about the larger and most difficult to replace providers for which the CQC will provide financial oversight. It should review the intelligence it has about the sustainability of care providers drawn from market shaping, commissioning and contract management activities.

Where the authority believes there is a significant risk to a provider’s financial viability, and where they consider it would be in the best interests of service users, the authority should consider what assistance may be provided or brokered to help the provider return to viability, and consider what actions might be needed were that provider to fail. For example, where a local authority has arranged services for people with a provider that appears to be at risk, it should undertake early planning to identify potential replacement service capacity. Where it is apparent to a local authority that a provider is likely to imminently fail financially, either through its own intelligence or through information from the CQC, the authority should prepare to step in to ensure continuity of care and support for people who have their care and support provided by that provider (see Managing Provider Failure and other Service Interruptions chapter).

3.4 Ensuring choice

The local authority must encourage a variety of different providers and different types of services. This is important in order to facilitate an effective open market, driving quality and cost-effectiveness so as to provide genuine choice to meet the range of needs and reasonable preferences of local people who need care and support services, including for people who choose to take direct payments, recognising, for example, the challenges presented in remote rural areas for low volume local services.

It must encourage a range of different types of service provider organisations to ensure people have a genuine choice of different types of service. This will include independent private providers, third sector, voluntary and community based organisations, including user-led organisations, mutual and small businesses. Local authorities should note that the involvement of people with specific lived experience of the type of needs being met, may lead to better outcomes for people who use services and carers as they directly empathise with service users. This should recognise that the different underpinning philosophies, cultural sensitivity and style of service of these organisations may be more suited to some people with care and support needs. The local authority should consider encouraging and supporting providers or taking other steps to promote an appropriate balance of provision between types of provider, having regard to competition rules and the need for fairness and legal requirements for all potential providers who may wish to compete for contracts.

When commissioning services to meet people’s eligible needs, where a local authority develops approved lists and frameworks that are used to limit the number of providers they work with, for example within a specific geographical area or for a particular service type to achieve strategic partnerships and value for money, the local authority must consider how to ensure that there is still a reasonable choice for people who need care and support.

It should encourage a genuine choice of service type, not only a selection of providers offering similar services, encouraging, for example, a variety of different living options such as shared lives, extra care housing, supported living, support provided at home, and live-in domiciliary care as alternatives to homes care, and low volume and specialist services for people with less common needs.

Choice for people who need care and support and carers should be interpreted widely. The local authority should encourage choice over the way services are delivered, for example:

  • developing arrangements so that care can be shared between an unpaid carer or relative and a paid care worker;
  • choice over when a service is delivered;
  • choice over who is a person’s key care worker;
  • arranging for providers to collaborate to ensure the right provision is available, for example, a private provider and a voluntary organisation working together;
  • choice over when a service is delivered.

The local authority must have regard to ensuring a sufficiency of provision – in terms of both capacity and capability – to meet anticipated needs for all people in its area needing care and support – regardless of how they are funded. This will include regularly reviewing trends in needs including multiple and complex needs, outcomes sought and achieved, and trends in supply, anticipating the effects and trends in prevention and community-based assets, and through understanding and encouraging changes in the supply of services and providers’ business and investment decisions.

When considering the sufficiency and diversity of service provision, it should consider all types of service that are required to provide care and support for the local authority’s whole population, including for example:

  • support services and universal and community services that promote prevention;
  • domiciliary (home) care;
  • homes and other types of accommodation care;
  • nursing care;
  • live-in care services;
  • specialist care;
  • support for carers;
  • reablement services;
  • sheltered accommodation and supported living;
  • shared lives services;
  • other housing options;
  • community support;
  • counselling;
  • social work;
  • information, brokerage, advocacy and advice services;
  • direct payment support organisations.

This will include keeping up to date with innovations and developments in services, networking through for example, the Association of Directors of Adult Social Services (ADASS), Think Local Act Personal (TLAP) and the Local Government Association (LGA).

The local authority should facilitate the personalisation of care and support services, encouraging services (including small, local, specialised and personal assistant services that are highly tailored), to enable people to make meaningful choices and to take control of their support arrangements, regardless of service setting or how their personal budget is managed. Local authorities should have regard to the TLAP Partnership agreement that sets out how shaping markets to meet people’s needs and aspirations, including housing options, can promote choice and control. Alongside the suitability of living accommodation, the local authority should consider how it can encourage the development of accommodation options that can support choice and control and promote wellbeing. Personalised care and support services should be flexible so as to ensure people have choices over what they are supported with, when and how their support is provided and wherever possible, by whom. The mechanism of Individual Service Funds by service providers, which are applicable in many different service types, can help to secure these kinds of flexibilities for people and providers.

The local authority should help people who fund their own services or receive direct payments, to ‘micro-commission’ care and support services and / or to pool their budgets, and should ensure a supporting infrastructure is available to help with these activities. Many local authorities, for example, are utilising web based systems such as e-Marketplaces for people who are funding their own care or are receiving direct payments to be able to search for, consider and buy care and support services online, or consider joint purchases with others. This often involves offering information and advice about, for example, the costs and quality of services and information to support safeguarding. See also Information and Advice chapter. This should include facilitating organisations that support people with direct payments and those whose care is funded independently from the local authority to become more informed and effective consumers and to overcome potential barriers such as help to recruit and employ personal assistants and to assist in overcoming problems and issues. This activity should help to match people’s wider needs with services.

Local authorities must facilitate information and advice to support people’s choices for care and support. This should include where appropriate through services to help people with care and support needs understand and access the systems and processes involved and to make effective choices. This is a key aspect of the duty to establish and maintain a universal information and advice service locally. Information and advice services should be reviewed for effectiveness using people’s experiences and feedback. This feedback forms part of the overall information a local authority considers about people’s needs and aspirations.

The local authority should facilitate local markets to encourage a sufficiency of preventative, enablement and support services, including support for carers to make caring more sustainable, such as interpreters, signers and communicator guides, and other support services such as telecare, home maintenance and gardening that may assist people achieve more independence and support the outcomes they want.

The local authority should encourage flexible services to be developed and made available that support people who need care and support, and carers who need support, to take part in work, education or training. Services should be encouraged that allow carers who live in one local authority area but care for someone in another local authority area to access services easily, bearing in mind guidance on ordinary residence.

3.5 Co-production with stakeholders

Local authorities should pursue the principle that market shaping and commissioning should be shared endeavours, with commissioners working alongside people with care and support needs, carers, family members, care providers, representatives of care workers, relevant voluntary, user and other support organisations and the public to find shared and agreed solutions (see also the TLAP guidance on co-production).

3.6 Developing local strategies

Commissioning and market shaping should be fundamental means for local authorities to facilitate effective services in their area and it is important that authorities develop evidence-based local strategies for how they exercise these functions, and align these with wider corporate planning.  It should publish strategies that include plans that show how its legislative duties, corporate plans, analysis of local needs and requirements (integrated with the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy), thorough engagement with people, carers and families, market and supply analysis, market structuring and interventions, resource allocations and procurement and contract management activities translate (now and in future) into appropriate high quality services that deliver identified outcomes for the people in their area and address any identified gaps.

Market shaping and commissioning intentions should be cross-referenced to the JSNA, and should be informed by an understanding of the needs and aspirations of the population and how services will adapt to meet them. Strategies should be informed and emphasise preventative services that encourage independence and wellbeing, delaying or preventing the need for acute interventions (see also Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies chapter).

Market shaping and commissioning should become an integral part of understanding and delivering the whole health and care economy, and reflect the range and diversity of communities and people with specific needs, in particular:

  • people needing care and support themselves (through for example, consumer research);
  • carers;
  • carer support organisations;
  • health professionals;
  • care and support managers and social workers (and representative organisations for these groups);
  • relevant voluntary, user and other support organisations;
  • independent advocates;
  • wider citizens;
  • provider organisations (including where appropriate housing providers); and
  • other tiers of local government.

A co-produced approach will stress the value of meaningful engagement with people at all stages, through design, delivery and evaluation, rather than simply as ‘feedback’. The local authority should publish and make available its local strategies for market shaping and commissioning, giving an indication of timescales, milestones and frequency of activities, to support local accountability and engagement with the provider market and the public.

The local authority can best start implementing its statutory responsibilities in relation to market shaping and commissioning and provider failure by developing with providers and stakeholders a published Market Position Statement. It may be helpful for Market Position Statements from neighbouring local authority areas to be coordinated to ensure a degree of consistency for people who will use the documents; this is particularly true for urban areas.

The local authority should review strategies related to care and support together with stakeholders to ensure they remain fit for purpose, learn lessons, and adapt to incorporate emerging best practice, noting that peer review has a strong track record in driving improvement. It is suggested that reporting against strategies for care and support should form part of the local authority’s Local Account.

Many public sector bodies, including local authorities, have radically transformed services by reconsidering commissioning in a strategic context. The Government’s Commissioning Academy is working to promote such transformational approaches and local authorities should have regard to the emerging best practice it is producing.

Developing a diverse market in care and support services can boost employment and create opportunities for local economic growth, through for example, increasing employment opportunities for working age people receiving care and carers, and developing the capacity of the care workforce. Local authorities should consider how their strategies related to care and support can be embedded in wider local growth strategies, for example, engaging care providers in local enterprise partnerships.

The local authority should have regard to best practice on efficiency and value for money (see also the Local Government Association Care and Health Efficiency).

The local authority strategies should adhere to general standards, relevant laws and guidance, including the Committee on Standards in Public Life principles of accountability, regularity and ensuring value for money alongside quality, and the HM Treasury guidance on Managing Public Money. Standards should be in line with the codes of practice drawn up by the Department for Levelling Up, Housing and Communities.

Local authorities should take the lead to engage with a wide range of stakeholders and citizens in order to develop effective approaches to care and support, including through developing the JSNA and a Market Position Statement. While the duties under the Care Act fall upon local authorities, successful market shaping is a shared endeavour that requires a range of coordinated action by commissioners and providers, working together with the citizen at the centre.  Local authorities should engage and cooperate with stakeholders to reflect the range and diversity of communities and people with specific needs, for example:

  • people needing care and support themselves and their representative organisations;
  • carers and their representative organisations;
  • health professionals;
  • social care managers and social workers;
  • independent advocates;
  • support organisations that help people who need care consider choices (including financial options);
  • provider organisations (including where appropriate housing providers and registered social landlords);
  • wider citizens and communities including individuals and groups who are less frequently heard (for example, LGBT communities where there may be a lack of data on care and support needs and preferences) or at risk from exclusion, including those who have communication issues and involving representatives of those who lack mental capacity.

Engagement with people needing care and support, people likely to need care and support, carers, independent advocates, families and friends, should emphasise understanding the needs of individuals and specific communities, what aspirations people have, what outcomes they would like to achieve, their views on existing services and how they would like services to be delivered in the future. It should also seek to identify the types of support and resources or facilities available in the local community which may be relevant for meeting care and support needs, to help understand and build community capacity to reinforce the more formal, regulated provider market. In determining an approach to engagement, local authorities should consider methods that enable people to contribute meaningfully to:

  • setting the strategic direction for market shaping and commissioning;
  • engaging in planning – using methods that support people to identify problems and solutions, rather than relying on ‘downstream’ consultation;
  • identifying outcomes and set priorities for specific services;
  • setting measures of success and monitor ongoing service delivery, including through the experience of people who use services and carers;
  • playing a leading role throughout tendering and procurement processes, from developing specifications to evaluating bids and selecting preferred providers;
  • contributing to reviews of services and strategies that relate to decommissioning decisions and areas for new investment;
  • managing any changes to service delivery, recognising that long-term relationships may have developed in the community and with individual people receiving care and support and carers.

Engagement with service providers should emphasise understanding the organisation’s strategies, risks, plans, and encourage building trusting relationships and fostering improvement and innovation to better meet the needs of people in the area. The local authority should consider engagement with significant suppliers of services to provider organisations, where this would help improve its understanding of markets, for example, engaging with employment and training services that might enable local authorities to gain access to frontline insights on care provision and the local workforce supply and training.

The local authority should ensure that active engagement and consultation with local people is built into the development and review of their strategies for market shaping and commissioning, and is demonstrated to support local accountability (for example, via the Local Account).

It should engage positively with provider organisations to ensure fair play and necessary confidentiality. See Commissioning the Future: start a new conversation.

The local authority should make available to providers available routes to register concerns or complaints about engagement and commissioning activities (see Complaints chapter). Local authorities should consider the adequacy and effectiveness of these routes and processes as part of their engagement and trust building activities.

4. Undertaking Market Shaping and Commissioning

4.1 Understanding the market

The local authority must understand local markets and develop knowledge of current and future needs for care and support services, and, insofar as they are willing to share and discuss, understand providers’ business models and plans. This is important so that the authority can articulate likely trends in needs and signal to the market the likely future demand for different types of services for its market as a whole, and understand the local business environment, to support effective commissioning. Activities to understand the market should appropriately reflect an authority’s strategic plans for integrating health, social care and related services and will require the cooperation of those other parties, as well as other authorities in the region, to ensure a complete picture.

The local authority (through an engagement process, in concert with commissioners for other services where appropriate) should understand and articulate the characteristics of current and future needs for services. This should include reference to underpinning demographics, drivers and trends, the aspirations, priorities and preferences of those who will need care and support, their families and carers, and the changing care and support needs of people as they progress through their lives. This should include an understanding of:

  • people with existing care needs drawn from assessment records;
  • carers with existing care needs drawn from carers’ assessment records;
  • new care and support needs;
  • those whose care and support needs will transition from young people’s services to adult services;
  • those transitioning from working-age adults to services for older people;
  • people whose care and support needs may fluctuate;
  • people moving to higher needs and specialised care and support; and
  • those that will no longer need care and support.

It should include information and analysis of low incidence needs and multiple and complex conditions, as well as more common conditions such as sensory loss. It should also include information about likely changes in requirements for specialist housing required by people with care and support needs. See also the online tool shop@, Housing Learning and Improvement Network.

The local authority should have in place robust methods to collect, analyse and extrapolate this information about care and support needs, including as appropriate information about specific conditions (for example, neurological conditions such as Stroke, Parkinson’s, Motor Neurone Disease), and multiple and complex needs. This should sit alongside information about providers’ intentions to deliver support over an appropriate timescale – likely to be at least five years hence, with alignment to other strategic time frames. Data collection should include information on the quality of services provided in order to support local authority duties to foster continuous improvement. This could be achieved, for example, by collecting and acting on feedback from people who receive care, their families and carers alongside information on the specific nature of the services people receive (e.g. regularity and length of homecare visits). This will allow for an assessment of correlation between customer experience and service provision. Data collection must be sufficient to allow local authorities to meet their duties under the Equality Act 2010.

The local authority should include in its engagement and analysis services and support provided by voluntary, community services, supported housing providers, and other groups that make up ‘community assets’ and plan strategically to encourage, make best use of and grow these essential activities to integrate them with formal care and support services.

The local authority should also seek to understand trends and changes to the levels of support that are provided by carers, and seek to develop support to meet its needs, noting that amongst other sources, census data include information on carers and their economic activity. It should understand the trends and likely changes to the needs of carers in employment, so as to better plan future support.

In order to understand future trends in needs and demands, the local authority should include an understanding of people who are or are likely to be both wholly or partly state funded, and people who are or are likely to be self-funding. It should also include an analysis of those self-funders who are likely to move to state funding in the future.

The understanding of needs should also include an understanding of the likely demand for state funded services that the local authority will need to commission directly, and state funded services likely to be provided through direct payments and require individuals to ‘micro-commission’ services. The local authority should also consider the extent to which people receiving services funded by the state may wish to ‘top up’ their provision to receive extra services or premium services; that is, the assessment of likely demand should be for services that people are likely to need and be prepared to pay for through top ups.

The assessment of needs should be integrated with the process of developing, refining and articulating a local authority’s Joint Strategic Needs Assessment. Where appropriate, needs should be articulated on an outcomes basis.

In order to gather the necessary information to shape its market, the local authority should engage with providers (including the local authority itself if it directly provides services) to seek to understand and model current and future levels of service provision supply, the potential for change in supply, and opportunities for change in the types of services provided and innovation possible to deliver better quality services and greater value for money. It should understand the characteristics of providers’ businesses, their business models, market concentration, investment plans etc. Information about both supply and expected demand for services should be made available publicly to help facilitate the market and empower communities and citizens when considering care and support. Smaller care providers should be included in engagement.

Assessment of supply and potential demand should include an awareness and understanding of current and future service provision and potential demand from outside the local authority area where this is appropriate, for example in considering services to meet highly specialised and complex needs, care and support may not be available in the local authority area, but only from a small number of specialised providers in the country. Consideration should be given to whether such services might better be commissioned and facilitated regionally.

4.2 Facilitating the development of the market

The local authority should collaborate with stakeholders and providers to bring together information about needs and demands for care and support with that about future supply, to understand for their whole market the implications for service delivery. This will include understanding and signalling to the market as a whole the need for the market to change to meet expected trends in needs, adapt to enhance diversity, choice, stability and sustainability, and consider geographic challenges for particular areas. To this picture, the local authority should add their own commissioning strategy and future likely resourcing for people receiving state funding. The local authority should consider coordinating these market shaping and related activities with other neighbouring authorities where this would provide better outcomes.

The local authority should consider how to support and empower effective purchasing decisions by people who self-fund care or purchase services through direct payments, recognising that this can help deliver a more effective and responsive local market.

It should ensure that the market has sufficient signals, intelligence and understanding to react effectively and meet demand, a process often referred to as market structuring or signalling. The local authority should publish, be transparent and engage with providers and stakeholders about the needs and supply analysis to assist this signalling. It is suggested that this is best achieved through the production and regular updating of a document like a Market Position Statement that clearly provides evidence and analysis and states the local authority’s intent. A Market Position Statement is intended to encourage a continuing dialogue between a local authority, stakeholders and providers, where that dialogue results in an enhanced understanding by all parties is an important element of signalling to the market.

A Market Position Statement should contain information on: the local authority’s direction of travel and policy intent, key information and statistics on needs, demand and trends, (including for specialised services, personalisation, integration, housing, community services, information services and advocacy, and carers’ services), information from consumer research and other sources about people’s needs and wants, information to put the authority’s needs in a national context, an indication of current and future authority resourcing and financial forecasts, a summary of supply and demand, the authority’s ambitions for quality improvements and new types of services and innovations, and details or cross-references to the local authority’s own commissioning intentions, strategies and practices.

Developing and publishing a Market Position Statement is one way a local authority can meet its duties to make available information about the local market, and demonstrate activity to meet other parts of the Care Act 2014. Market Position Statements for care and support services should combine, cross refer or otherwise complement other similar statements for related services, particularly where there is an integrated approach or ambition, for example, housing.

As part of developing and publishing a document like a Market Position Statement, the local authority should engage with stakeholders and partners to structure their markets. This could include:

  • discussions with potential providers;
  • actively promoting best practice and models of care and support;
  • understanding the business planning cycles of providers;
  • aligning interactions and supporting the provider’s business planning;
  • identifying and addressing barriers to market entry for new providers;
  • facilitating entry to the market through advice and information;
  • streamlining the authority’s own procurement processes;
  • promoting diversification of provider organisations;
  • working with providers on an ‘open-book accounting’ approach to cost current and future services and ensure provider sustainability;
  • supporting providers through wider local authority activity – planning, business support and regeneration.

The local authority may consider that market structuring activity – signalling to the market and providing assistance – is not achieving the strategic aims as quickly or as effectively as needed, and may wish to consider more direct interventions in the market. Market interventions may also be planned as part of the market shaping and commissioning strategies where there is an immediate need for intervention.

Market interventions could for example include: refocusing local authority business support initiatives onto the care and support sector, exploring how local care and support projects could attract capital investments and support and what guarantees may be needed, encouraging and supporting social enterprises, micro-enterprises, Community Interest Companies, and User Led Organisations (for example, incentivising innovation by third sector providers, possibly through grant funding), exploring planning barriers and using planning law, offering access to training and development opportunities.

The local authority should consider monitoring progress toward the ambitions set out in the Market Position Statement, and making the progress public along with information about its own commissioning decisions, as part of a commitment to transparency and accountability. This would demonstrate that the authority’s commissioning activity is in line with the ambition and direction of travel articulated in its Market Position Statement, and might be achieved by including this information in regular updates to the Market Position Statement.

4.3 Promoting integration with local partners

The Health and Social Care Act 2012 sets out specific obligations for the health system and its relationship with care and support services. It gives a duty to NHS England, Integrated Care Boards and Health and Wellbeing Boards to make it easier for health and social care services to work together to improve outcomes for people. The local authority has a corresponding duty to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services, such as housing.

It should also consider working with appropriate partners to develop integration with services related to care and support such as housing, employment services, transport, benefits and leisure services. Local authorities should prioritise integration activity in areas where there is evidence that effective integration of services materially improves people’s wellbeing, for example, end of life care (see End of Life Care chapter), and should take account of the key national and local priorities and objectives of the Better Care Fund, for example, stopping people reaching crisis and reducing the emergency admissions to hospitals.

Integrated services built around an individual’s needs are often best delivered in the home. The suitability of living accommodation is a core component of an individual’s wellbeing and when developing integrated services, the local authority should consider the central role of housing within integration, with associated formal arrangements with housing and other partner organisations.

The local authority should work towards providing integrated care and support, providing services that work together to provide better outcomes for individuals who need care and support and enhancing their wellbeing, noting that this will require the sharing of information about current and future needs and likely service provider’s responses to underpin a holistic approach to developing integrated care and support pathways. See also Integration, Cooperation and Partnerships chapter.

The local authority should consider with partners the enabling activities, functions and processes that may facilitate effective integrated services. These will include consideration of: joint commissioning strategies, joint funding, pooled budgets, lead commissioning, collaborative commissioning, working with potential service providers to consider innovative ways of arranging and delivering services, and making connections to public health improvement.

4.4 Securing supply in the market and assuring its quality and value for money through contracting

Local authorities should consider best practice on commissioning services, for example the National Audit Office guidance Value for Money to ensure they deliver quality services with value for money. This means optimal use of resources to achieve intended outcomes, and must reference the quality of service delivered and the outcomes achieved for people’s wellbeing, and should not be solely based on achieving the lowest cost. Achieving value for money may mean arranging service provision collaboratively with other authorities, in order to secure viable, quality services that meet the demands identified, for example, low volume services.

Commissioning and procurement practices must deliver services that meet the requirements of the Care Act and all related statutory guidance. Re-commissioning and replacing services represents a particular challenge and should be carried out so as to maintain quality and service delivery that supports the wellbeing of people who need care and support and carers, and guards against the risk of a discontinuity of care and support for those receiving services. For example, multiple contracts terminating around the same time may destabilise local markets if established providers lose significant business rapidly and staff do not transfer smoothly to new providers.

Decommissioning services where there is to be no replacement service should similarly be carried out so as to maintain the wellbeing of people who need care and support, and carers, and ensures that their eligible needs continue to be met.

The local authority should consider the contract arrangements they make with providers to deliver services, including the range of block contracts, framework agreements, spot contracting or ‘any qualified provider’ approaches, to ensure that the approaches chosen do not have negative impacts on the sustainability, sufficiency, quality, diversity and value for money of the market as a whole – the pool of providers able to deliver services of appropriate quality.

A local authority’s own commissioning should be delivered through a professional and effective procurement, tendering and contract management, monitoring, evaluation and decommissioning process that must be focused on providing appropriate high quality services to individuals to support their wellbeing and supporting the strategies for market shaping and commissioning, including all the themes set out in this guidance.

The local authority should ensure that it understands relevant procurement legislation, and that its procurement arrangements are consistent with such legislation and best practice. It should be aware there is significant flexibility in procurement practices to support effective engagement with provider organisations and support innovation in service delivery, potentially reducing risks and leading to cost-savings. The Government has produced guidance on when reserved contracts may be allowable for organisations employing a significant number of disabled people.

4.5 Front line social work practice

The local authority should ensure that its procurement and contract management and monitoring systems provide direct and effective links to care service managers and social workers to ensure the outcomes of service delivery matches the individual’s care and support needs, and that where the local authority arranges services, people are given a reasonable choice of provider. Contract management should take account of feedback from people receiving care and support.

The local authority should ensure that where they arrange services, the assessed needs of a person with eligible care and support needs is translated into effective, appropriate commissioned services that are adequately resourced and meet the wellbeing principle (see Promoting Wellbeing chapter). For example, short home-care visits of 15 minutes or less are not appropriate for people who need support with intimate care needs, though such visits may be appropriate for checking someone has returned home safely from visiting a day centre, or whether medication has been taken (but not the administration of medicine) or where they are requested as a matter of personal choice.

4.6 Preventing abuse and neglect

When commissioning services, the local authority should pay particular attention to ensuring that providers have clear arrangements in place to prevent abuse or neglect. This should include assuring itself, through its contracting arrangements, that a provider is capable and competent in responding to allegations of abuse or neglect, including having robust processes in place to investigate the actions of members of staff. The local authority should be clear what information they expect from providers (for example, where there are allegations of abuse, what action the provider is taking or has taken and what the outcome is) and where providers are expected to call upon local authorities to lead a section 42 enquiry (where the management of the provider is implicated for instance), or to involve the Integrated Care Board (for health matters) or police (for example, in the case of potential crimes). There should be clear agreement about how local partners work together on investigations and their respective roles and responsibilities.

4.7 Financial sustainability

When commissioning services, the local authority should undertake due diligence about the financial sustainability and effectiveness of potential providers to deliver services to agreed criteria for quality, and should assure themselves that any recent breaches of regulatory standards or relevant legislation by a potential provider have been corrected before considering them during tendering processes. For example, where a provider has previously been in breach of national minimum wage legislation, a local authority should consider every legal means of excluding them from the tendering process unless they have evidence that the provider’s policies and practice have changed to ensure permanent compliance.

Contracts should incentivise value for money, sustainability, innovation and continuous improvement in quality and actively reward improvement and added social value. Contracts and contract management should manage and eliminate poor performance and quality by providers and recognise and reward excellence.

The local authority has a duty to consider added social value when letting contracts through the Public Services (Social Value) Act 2012, and are required to consider how the services it procures, above relevant financial thresholds, might improve the economic, social and environmental wellbeing of the area. The local authority should consider using this duty to promote added value in care and support both when letting contracts to deliver care and support, and for wider goods and services. This should include considering whether integrated services, voluntary and community services and ‘community capital’ could be enhanced, recognising that these community assets provide the bedrock of care and support that commissioned and bought services supplement. Local authorities should consider the range of funding mechanisms that are available to support market interventions to support community based organisations such as seed funding and grants.

All services delivered should adhere to national quality standards, with procedures in place to assure quality, safeguarding, consider complaints and commendations, and continuing value for money, referencing the Care Quality Commission (CQC) standards for quality and its quality ratings.

The local authority may consider delegating some forms of contracting to brokers and people who use care and support to support personal choice for people who are not funded by the local authority and those taking direct payments, with appropriate systems in place to underpin the delivery of safe, effective appropriate high quality services through such routes. Where functions and activities are delegated, local authorities should ensure that appropriate elements of this statutory guidance are included in contractual conditions, for example, allowing engagement in developing Market Position Statements. Local authorities should also consider providing support to people who wish to use direct payments to help them make effective decisions through, for example, direct payment support organisations.

Local authority procurement and contract management activities should seek to minimise burdens on provider organisations and reduce duplications, where appropriate, using and sharing information, with for example the CQC.

Recognising that procurement is taking place against a backdrop of significant demand on commissioners to achieve improved value for money and make efficiencies, local authorities should consider emerging practice on achieving efficiencies without undermining the quality of care.

5. Further Reading

5.1 Relevant chapter

Promoting Wellbeing

5.2 Relevant information

Chapter 4, Market Shaping and Commissioning of Adult Care and Support, Care and Support Statutory Guidance (Department of Health and Social Care)

Social Care Provider Resilience during Covid-19: Guidance for Commissioners (ADASS, LGA and CPA)

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Audio & Quick Read Summary

CQC Quality Statements

Theme 1 – Working with People: Supporting people to live healthier lives

We Statement

We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.

What people expect

I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.

KEY POINTS

  • Under the Care Act, the local authority is responsible for setting up and maintaining – including review – information and advice services relating to care and support.
  • All adults – including carers – in the local authority area, who need information and advice about care and support, must be able to access the service.
  • The local authority must ensure that the information provided is of good quality, easily accessible and relevant.
  • The local authority should take opportunities to provide or signpost people to advice and information when people in need of care and support are in contact.

1. Introduction

Having access to good quality information and advice is very important to enabling people, carers and families to take control of and make well informed choices about their care and support and how they will fund it. Not only does information and advice help to promote people’s wellbeing by increasing their ability to exercise choice and control, it is also a vital part of preventing or delaying people’s need for care and support.

The local authority has a legal duty to ‘establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers’ (Section 4, Care Act 2014).

The local authority must ensure that information and advice services established cover more than just basic information about care and support and cover a wide range of care and support related areas. The service should also address prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required.

Local authorities should consider who are the people they are communicating with on a case by case basis, and signpost them towards information and / or advice that may be particularly relevant to them.

Local authorities must also provide independent advocacy to assist a person’s involvement in the care and support assessment, planning and review processes where they would otherwise have substantial difficulty in understanding, retaining or using information given to them, or in communicating their views, wishes or feelings and where there is nobody else who can offer this support (see Independent Advocacy chapter).

2. The Local Authority’s Legal Duty to Establish and Maintain a Service

Under the Care Act, the local authority must establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers. This should be in conjunction with partner organisations and be informed by local Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies (see also Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies chapter).

It is also responsible for ensuring appropriate quality assurance and review of the service. This should include feedback from local people who use it, to make sure that the service learns from people’s experiences and continuously improves.

3. Terms Used

The Care and Support Statutory Guidance uses a number of different terms, which are included in this chapter.

‘Information’ means the communication of knowledge and facts about care and support.

‘Advice’ means helping a person to identify choices and / or providing an opinion or recommendation regarding a course of action in relation to care and support.

‘Advocacy’ means supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need.

The term ‘financial information and advice’ includes a broad range of services to  help people plan, prepare and pay for their care costs.

‘Independent’ financial information or advice means services independent of the local authority. It also refers to ‘regulated’ financial advice which means advice from an organisation which is regulated by the Financial Conduct Authority (FCA) which can include individual recommendations about specific financial products.

Local authorities should ensure that people are able to access all of these types of financial information and advice to help them plan and pay for their care.

4. Who are the Information and Advice Services for?

The local authority is responsible for ensuring that all adults – including carers – in its area, who need information and advice about care and support, can access the service.

People who are likely to need information and advice may include:

  • people wanting to plan for their future care and support needs;
  • people who may develop care and support needs, or whose current care and support needs may increase. Under the Care Act, local authorities are expected to take action to prevent, delay and / or reduce the care and support needs for these people (see Preventing, Reducing or Delaying Needs chapter);
  • people who have not contacted the local authority for assessment but are likely to be in need of care and support. Local authorities are expected to take steps to identify such people and encourage them to come forward for an assessment of their needs (see Preventing, Reducing or Delaying Needs chapter);
  • people who become known to the local authority (through referral, including self-referral), at first contact where an assessment of their needs is being considered (see Assessment chapter);
  • people who are assessed by local authority as currently being in need of care and support. Advice and information must be offered to these people irrespective of whether they have been assessed as having eligible needs which the local authority must meet;
  • people who have eligible needs for care and support which the local authority is currently meeting (whether the local authority is paying for some, all or none of the costs of meeting those needs (see Care and Support Planning);
  • people whose care and support or support plans are being reviewed (see Review of Care and Support Plans);
  • family members and carers of adults with care and support needs, (or those who are likely to develop care and support needs). Local authorities are expected to have regard to the importance of identifying carers and take action to reduce their needs for support (see Assessment);
  • adults who are subject to adult safeguarding concerns (see Adult Safeguarding);
  • people who may benefit from financial information and advice on matters concerning care and support. Local authorities must consider the importance of identifying these people, to help them understand the financial costs of their care and support and access independent financial information and advice including from regulated financial advisers (see Financial Information and Advice), and;
  • care and support staff who have contact with and provide information and advice as part of their jobs.

4.1 Carers

The local authority must recognise and respond to specific requirements that carers have for both general and personal information and advice. A carer’s need for information and advice may be distinct from information and advice for the person for whom they are caring. Their needs may be covered together, in a similar way to the local authority combining an assessment of a person needing care and support with a carer’s assessment (see Assessments – Carers), but may be more appropriately considered separately. This may include information and advice on:

  • breaks from caring;
  • the health and wellbeing of carers themselves;
  • caring and advice on wider family relationships;
  • carers’ financial and legal issues;
  • caring and employment;
  • caring and education; and,
  • a carer’s need for advocacy.

5. Quality of Information and Advice

The local authority must ensure that there is an accessible information and advice service that meets the needs of its population. Information and advice must be open to everyone who would benefit from it.

Local authorities should ensure that information supplied is clear, meaning it can be understood and able to be acted upon by the person receiving it.

It should be accurate, up to date and consistent with other sources of information and advice. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained. See Section 8, Accessibility of Information and Advice.

All reasonable efforts should be taken to ensure that information and advice provided meets the adult’s requirements, is comprehensive and is given at an early stage. The local authority must make sure that all relevant information is available to people so they can make the best informed decision in their particular circumstances.  Leaving out or withholding of information is not acceptable.

There will be some circumstances where impartial information and advice are particularly important and the local authority should consider when this may be best provided by an independent organisation, rather than by the local authority itself. This is particularly likely to be the case when people need advice about if, how and when to question or challenge the decisions of the local authority.

6. Content

The local authority must ensure that information and advice is provided on:

  • how the local care and support system works locally – about how the system works. This includes an outline of what the ‘process’ may involve and the judgements that may need to be made;  specific information on what the assessment process, eligibility, and review stage are; how to complain or make a formal appeal to the authority, what this involves and when independent advocacy should be provided. It also includes wider information and advice to support individual wellbeing; the charging arrangements for care and support costs; how a person might plan for their future care and support needs and how to pay for them, including provision for the possibility that they may not have capacity to make decisions for themselves in the future
  • how to access the care and support available locally – where, how and with whom to make contact, including information on how and where to request an assessment of needs, a review or to complain or appeal against a decision;
  • the choice of types of care and support, and the choice of care providers available in the local area – including prevention and reablement services and wider services that support wellbeing. Where possible this should include the likely costs to the person of the care and support services available to them. Information on different types of service or support that allow people personal control over their care and support for example, details of Independent Service Funds, and direct payments should be included;
  • how to access independent financial advice on matters relating to care and support – including the extent of their personal responsibilities to pay for care and support, their rights to statutory financial and other support, locally and nationally, so that they understand what care and support they are entitled to from the local authority or other statutory providers. Details of the information and advice people may wish to consider when making financial decisions about care so that they can make best use of their financial resources and are able to plan for their personal costs of care whether immediately or in the future;
  • how to raise concerns about the safety or wellbeing of an adult with care and support needs and also consider how to do the same for a carer with support needs.

Depending on local circumstances, the service should also include, but not be limited to, information and advice on:

  • available housing and housing related support options for those with care and support needs;
  • effective treatment and support for health conditions, including Continuing Health Care arrangements;
  • availability and quality of health services;
  • availability of services that may help people remain independent for longer such as home improvement agencies, handyperson or maintenance services;
  • availability of befriending services and other services to prevent social isolation;
  • availability of intermediate care entitlements such as aids and adaptations;
  • eligibility and applying for disability benefits and other types of benefits;
  • availability of employment support for disabled adults;
  • children’s social care services and transition from children’s services to adult care and support services;
  • availability of carers’ services and benefits;
  • sources of independent information, advice and advocacy;
  • the Court of Protection, power of attorney and becoming a deputy;
  • the need to plan for future care costs;
  • practical help with planning to meet future or current care costs;
  • accessible ways and support to help people understand the different types of abuse and its prevention.

7. Opportunities to Provide Information and Advice

Local authorities have a number of direct opportunities to provide or signpost people to advice and information when people in need of care and support come into contact with them. These include:

  • at first point of contact with the local authority;
  • as part of a needs or carer’s assessment, including joint Continuing Healthcare assessments;
  • during a period of reablement;
  • around and following financial assessment;
  • when considering a financial commitment such as a deferred payment agreement or top‑up agreement;
  • during or following an adult safeguarding enquiry;
  • when considering take up of a personal budget and / or direct payment;
  • during the care and support planning process;
  • during the review of a person’s care and support plan;
  • when a person may be considering a move to another local authority area;
  • at points in transition, for example when people needing care or carers under 18 become adults and the systems for support may change.

The local authority and its partners must also use wider opportunities to provide targeted information and advice at key points in people’s contact with the care and support, health and other local services. These may be at key ‘trigger points’ during a person’s life such as:

  • contact with other local authority services;
  • bereavement;
  • hospital entry and / or discharge;
  • diagnosis of health conditions – such as dementia, stroke or an acquired impairment for example;
  • consideration or review of Continuing Healthcare arrangements;
  • take up of power of attorney;
  • applications to the Court of Protection;
  • application for, or review of, disability benefits such as Attendance Allowance, Personal Independence Payments, and for Carer’s Allowance;
  • access to work interviews;
  • contact with local support groups, charities, or user-led organisations including carers’ groups and disabled person’s organisations;
  • contact with or use of private care and support services, including homes care;
  • change or loss of housing;
  • contact with the criminal justice system;
  • admission to or release from prison;
  • ‘guidance guarantee’ in the Pensions Act 2014;
  • retirement.

8. Accessibility of Information and Advice

The local authority should ensure that products and materials (in all formats) are as accessible as possible for all potential users. Websites should meet specific standards such as the Web Content Accessibility Guidelines and guidance set out in the Government Digital Service’s (GDS) service manual.

Printed products should be produced to appropriate guidelines with important materials available in easy read, large print and languages other than English. Telephone services or face to face services should also be available to people who do not have access to the internet or who need services to be delivered in another way to meet their specific needs. Local authorities should particularly be aware of the needs of individuals with complex but relatively rare conditions, such as deafblindness and those with hidden disabilities (see Working with Adults with Hidden Disabilities chapter).

Under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in a range of accessible formats or the provision of help with communication support. When a person contacts the information or advice service, they should be asked what the best way for information is to be given to them and how they prefer to communicate.

Advice and information content should be available in a range of formats, including:

  • face to face contact;
  • use of social and professional contacts;
  • community settings;
  • advice and advocacy services;
  • telephone;
  • mass communications, and targeted use of leaflets, posters and so on (for example in GP surgeries);
  • use of ‘free’ media such as newspaper, local radio stations, social media;
  • the local authority’s own and other appropriate internet websites, including support for the self-assessment of needs;
  • third party internet content and applications;
  • email.

Some groups in need of information and advice about care and support may have particular requirements. These may include:

  • people with sensory impairments, such as visual impairment, deafblind and hearing impaired;
  • people who do not have English as a first language;
  • people who are socially isolated;
  • people whose disabilities limit their physical mobility;
  • people with learning disabilities;
  • people with mental health problems.

Some people, including those with dementia, may benefit from an independent person to help them to access necessary information and advice. From the point of first contact with, or referral to, the local authority the provision of independent advocacy to support involvement in assessment, planning and reviews should be considered (see Independent Advocacy).

9. Adult Safeguarding

The local authority and its partners have a duty to help people with care and support needs, and who may be at risk of abuse or neglect as a result of their needs, keep safe. But this does not prevent them making their own choices and having control over their lives. Everyone should understand the importance of safeguarding and help keep people safe (see Adult Safeguarding).

The local authority must provide information and advice about how to raise concerns about the safety or wellbeing of an adult who has care and support needs. It should also support public knowledge and awareness of different types of abuse and neglect, how to keep oneself physically, sexually, financially and emotionally safe, and how to support people to keep safe.

The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on how the Knowsley Safeguarding Adults Board works.

10. Complaints

Anyone who is dissatisfied with a decision made by the local authority would be able to make a complaint about that decision and have that complaint handled by the local authority. The local authority must make its own arrangements for dealing with complaints. As an essential part of how the whole system operates, the local authority’s arrangements must ensure that those who make complaints receive, as far as reasonably practicable, assistance to enable them to understand the complaints procedure or advice on where to obtain such assistance. See Complaints chapter.

11. National Organisations

The local authority should consider the appropriate interface and balance between local and national sources of information and advice. Where appropriate, it should signpost or refer people to national sources of information and advice where these are recognised as the most useful source.  Examples might include:

Some national providers offer free access to tools, resources and information that can be integrated into local authority websites or delivered in paper format.

Referral or signposting to national sources however should only occur in the person’s best interests.

12. Further Reading

12.1 Relevant chapters

Financial Information and Advice

Promoting Wellbeing

Preventing, Reducing or Delaying Needs

12.2 Relevant information

Chapter 3, Information and Advice, Care and Support Statutory Guidance (Department of Health and Social Care)

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Audio & Quick Read Summary

CQC Quality Statements

Theme 1 – Working with People: Supporting people to live healthier lives

We Statement

We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.

What people expect

I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.

1. Introduction

It is critical to the vision in the Care Act 2014 that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it will be vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible.

There are many ways in which a local authority can achieve the aims of promoting wellbeing and independence and reducing dependency. The Care and Support Statutory Guidance) sets out how local authorities should go about fulfilling their responsibilities, both individually and in partnership with other local organisations, communities, and people themselves.

The local authority’s responsibilities for prevention, reducing and delaying needs apply to all adults, including:

  • people who do not have any current needs for care and support;
  • adults with needs for care and support, whether their needs are eligible and / or met by the local authority or not;
  • carers, including those who may be about to take on a caring role or who do not currently have any needs for support, and those with needs for support which may not be being met by the local authority or other organisation.

The term ‘prevention’ or ‘preventative’ measures can cover many different types of support, services, facilities or other resources. There is no single definition for what constitutes preventative activity and this can range from wide scale, whole population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one person or a particular group or lessening the impact of caring on a carer’s health and wellbeing. In considering how to give effect to their responsibilities, local authorities should consider the range of options available, and how those different approaches could support the needs of their local communities.

‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention – which are described in more detail below. The use of such terms is aimed to illustrate what type of services, facilities and resources could be considered, arranged and provided as part of a prevention service, as well as to whom and when such services could be provided or arranged. However, services can cut across any or all of these three general approaches and as such the examples provided under each approach are not to be seen as limited to that particular approach. Prevention should be seen as an ongoing consideration and not a single activity or intervention.

2. Prevent, Reduce, Delay

2.1 Prevent: primary prevention/ promoting wellbeing

These are aimed at individuals who have no current particular health or care and support needs. These are services, facilities or resources provided or arranged that may help an individual avoid developing needs for care and support, or help a carer avoid developing support needs by maintaining independence and good health and promoting wellbeing. They are generally universal (that is, available to all) services, which may include interventions and advice that:

  • provide universal access to good quality information;
  • support safer neighbourhoods;
  • promote healthy and active lifestyles;
  • reduce loneliness or isolation or;
  • encourage early discussions in families or groups about potential changes in the future, for example conversations about potential care arrangements or suitable accommodation should a family member become ill or disabled.

2.2 Reduce: secondary prevention/ early intervention

These are more targeted interventions aimed at individuals who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing. Some early support can help stop a person’s life tipping into crisis, for example helping someone with a learning disability with moderate needs manage their money, or a few hours support to help a family carer who is caring for their son or daughter with a learning disability and behaviour that challenges at home.

Early intervention could also include a fall prevention clinic, adaptations to housing to improve accessibility or provide greater assistance, handyman services, short term provision of wheelchairs or telecare services. In order to identify those individuals most likely to benefit from such targeted services, local authorities may undertake screening or case finding, for instance to identify individuals at risk of developing specific health conditions or experiencing certain events (such as strokes, or falls), or those that have needs for care and support which are not currently met by the local authority. Targeted interventions should also include approaches to identifying carers, including those who are taking on new caring responsibilities. Carers can also benefit from support to help them develop the knowledge and skills to care effectively and look after their own health and wellbeing.

2.3 Delay: tertiary prevention

These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired (see also Sight Registers chapter). Local authorities must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as the provision of formal care such as meeting a person’s needs in their own home; rehabilitation / reablement services, for example community equipment services and adaptations; and the use of joint case management for people with complex needs.

Tertiary prevention services could also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through respite care, peer support groups like dementia cafés, or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others. This can help develop mechanisms to cope with stress associated with caring and help carers develop an awareness of their own physical and mental health needs.

Prevention is not a one off activity. For example, a change in the circumstances of an adult and/or carer may result in a change to the type of prevention activity that would be of benefit to them. Prevention can sometimes be seen as something that happens primarily at the time of (or very soon after) a diagnosis or assessment or when there has been a subsequent change in the person’s condition. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.

3. Intermediate Care and Reablement

‘Intermediate care’ is a time limited, structured programme of care to assist a person to maintain or regain their ability to live independently at home. ‘Reablement’ is a type of intermediate care, which aims to help the person regain their capabilities and live independently in their own home.

There are four models of intermediate care (see Intermediate Care (SCIE):

  1. Bed-based services are provided in an acute hospital, community hospital, residential care home, nursing home, standalone intermediate care facility, independent sector facility, local authority facility or other bed-based settings.
  2. Community-based services provide assessment and interventions to people in their own home or a care home.
  3. Crisis response services are based in the community and are provided to people in their own home or a care home with the aim of avoiding hospital admissions.
  4. Reablement services are based in the community and provide assessment and interventions to people in their own home or a care home. These services aim to help people recover skills and confidence to live at home and maximise their independence.

The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

‘Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support.

To prevent needs emerging across health and care, integrated services should draw on a mixture of qualified health, care and support staff, working collaboratively to deliver prevention. This could involve, for instance, reaching beyond traditional health or care interventions to help people develop or regain the skills of independent living and active involvement in their local community.

4. Carers and Prevention

Carers play a significant role in preventing the needs for care and support for the people they care for, which is why it is important that local authorities consider preventing carers from developing needs for care and support themselves. There may be specific interventions for carers that prevent, reduce or delay the need for carers’ support. These interventions may differ from those for people without caring responsibilities. Examples of services, facilities or resources that could contribute to preventing, delaying or reducing the needs of carers may include but is not limited to those which help carers to:

  • care effectively and safely – both for themselves and the person they are supporting, for example timely interventions or advice on moving and handling safely or avoiding falls in the home, or training for carers to feel confident performing basic health care tasks;
  • look after their own physical and mental health and wellbeing, including developing coping mechanisms;
  • make use of IT and assistive technology;
  • make choices about their own lives, for example managing their caring role and paid employment;
  • find support and services available in their area;
  • access the advice, information and support they need including information and advice on welfare benefits, other financial information and entitlement to carers’ assessments (see Assessment chapter).

As with the people they care for, the duty to prevent carers from developing needs for support is distinct from the duty to meet their eligible needs. While a person’s eligible needs may be met through universal preventative services, this will be an individual response following a needs or carers assessment. Local authorities cannot fulfil their universal prevention duty in relation to carers simply by meeting eligible needs, and nor would universal preventative services always be an appropriate way of meeting carers’ eligible needs.

5. The Focus of Prevention

5.1 Promoting wellbeing

The local authority must have regard to promote wellbeing and its principles (see Promoting Wellbeing), and view an individual’s life holistically. This will mean considering care and support needs in the context of the person’s skills, ambitions, and priorities. This should include consideration of the role a person’s family or friends can play in helping the person to meet their goals. This is not creating or adding to their caring role but including them in an approach supporting the person to live as independently as possible for as long as possible. In regard to carers, the local authority should consider how they can be supported to look after their own health and wellbeing and to have a life of their own alongside their caring responsibilities.

As highlighted in the case study, where people live alone a person may not always have the support from family or friends because they may not live close by. For this group of people prevention needs to be considered through other means, such as the provision of community services and activities that would help support people to maintain an independent life.

5.2 Developing resilience and promoting individual strength

In developing and delivering preventative approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services, but are able to design care and support based around achievement of their goals. Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ‘Co-production’ is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered. Such interventions can contribute to developing individual resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.

Through the assessment process, an individual will have direct contact with a local authority. A good starting point for a discussion that helps develop resilience and promotes independence would be to ask: ‘what does a good life look like for you and your family and how can we work together to achieve it?’ Giving people choice and control over the support they may need and access to the right information enables people to stay as well as possible, maintain independence and caring roles for longer.

Social workers, occupational therapists, other professionals, service providers and commissioners who are effective at preventing, reducing, or delaying needs for care and support are likely to have a holistic picture of the individuals and families receiving support. This will include consideration of a person’s strengths and their informal support networks as well as their needs and the risks they face. This approach recognises the value in the resources of voluntary and community groups and the other resources of the local area.

5.3 Developing a local approach to preventative support

The local authority must provide or arrange for services, facilities or resources which would prevent, delay or reduce an individual’s needs for care and support, or the needs for support of carers. It should develop a clear, local approach to prevention which sets out how they plan to fulfil this responsibility, taking into account the different types and focus of preventative support as outlined above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support.

5.4 Working with other partners to focus on prevention

Whilst local authorities may choose to provide some types of preventative support themselves, others may be more effectively provided in partnership with other local partners (for example rehabilitation or falls clinics provided jointly with the local NHS), and further types may be best provided by other organisations (for example specialist housing providers or some carers’ services). A local authority’s commissioning strategy for prevention should consider the different commissioning routes available, and the benefits presented by each. This could include connecting to other key areas of local preventative activity outside care, including housing, planning and public health.

In developing a local approach to prevention, the local authority must take steps to identify and understand both the current and future demand for preventative support, and the supply in terms of services, facilities and other resources available.

Local authorities must consider the importance of identifying the services, facilities and resources that are already available in their area, which could support people to prevent, reduce or delay needs, and which could form part of the overall local approach to preventative activity. Understanding the breadth of available local resources will help the local authority to consider what gaps may remain, and what further steps it should itself take to promote the market or to put in place its own services.

Where the local authority does not provide such types of preventative support itself, it should have mechanisms in place for identifying existing and new services, maintaining contact with providers over time, and helping people to access them. Local approaches to prevention should be built on the resources of the local community, including local support networks and facilities provided by other partners and voluntary organisations.

Local authorities must promote diversity and quality in provision of care and support services, and ensure that a person has a variety of providers to choose from (see Market Shaping and Commissioning of Adult Care and Support chapter). Considering the services, facilities and resources which contribute towards preventing or delaying the development of needs for care and support is a core element of fulfilling this responsibility. A local authority should engage local providers of care and support in all aspects of delivery and encourage providers to innovate and respond flexibly to develop interventions that contribute to preventing needs for care and support.

Local authorities should consider the number of people in its area with existing needs for care and support, as well as those at risk of developing needs in the future, and what can be done to prevent, delay or reduce those needs now and in the future. In doing so, a local authority should draw on existing analyses such as the Joint Strategic Needs Assessment, and work with other local partners such as the NHS and voluntary sector to develop a broader, shared understanding of current and future needs, and support integrated approaches to prevention (see Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies).

In particular, local authorities must consider how to identify ‘unmet need’ – that is those people with needs which are not currently being met, whether by the local authority or anyone else. Understanding unmet need will be crucial to developing a longer-term approach to prevention that reflects the true needs of the local population. This assessment should also be shared with local partners, such as through the health and wellbeing board, to contribute to wider intelligence for local strategies. Preventative services, facilities or resources are often most effective when brought about through partnerships between different parts of the local authority and between other agencies and the community such as those people who are likely to use and benefit from these services.

Local authorities should consider how they can work with different partners to identify unmet needs for different groups and coordinate shared approaches to preventing or reducing such needs, for example working with the NHS to identify carers, and working with independent providers including housing providers and the voluntary sector, who can provide local insight into changing or emerging needs beyond eligibility for publicly funded care.

5.5 Working with other partners to focus on prevention

Developing and delivering local approaches to prevention, the local authority should consider how to align or integrate its approach with that of other local partners. Preventing needs will often be most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.

Within the local authority, prevention of care and support needs is closely aligned to other local authority responsibilities in relation to public health, children’s services, and housing, for example. Across the local landscape, the role of other bodies including the local NHS (for example GPs, dentists, pharmacists, ophthalmologists etc.), welfare and benefits advisers (for example at Jobcentre Plus), the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach.

Local authorities must ensure the integration of care and support provision, including prevention with health and health-related services, which include housing (see Integration, Cooperation and Partnerships chapter). This responsibility includes in particular a focus on integrating with partners to prevent, reduce or delay needs for care and support.

A local authority must cooperate with each of its relevant partners and the partners must cooperate with the local authority, for example, in relation to the provision of preventative services and the identification of carers, a local authority must cooperate with NHS bodies.

A local authority must also set up arrangements between its relevant partners and individual departments in relation to its care and support functions, which includes prevention. Relevant partners and individual departments include, but are not limited to, housing departments where, for example, housing services or officers may be well placed to identify people with dementia and their carers, and provide housing related support and/or in partnership with others, home from hospital services or ‘step up step down’ provision.

5.6 Identifying those who may benefit from preventative support

The local authority should put in place arrangements to identify and target those individuals who may benefit from particular types of preventative support. Helping people to access such types of support when they need it is likely to have a significant impact on their longer term health and wellbeing, as well as potentially reducing or delaying the need for ongoing care and support from the local authority.

In developing such approaches, the local authority should consider the different opportunities for coming into contact with people who may benefit, including where the first contact maybe with a professional outside the local authority for example, GPs, pharmacists or welfare and benefit advisers. There are a number of interactions and access points that could bring a person into contact with the local authority or a partner organisation and act as a trigger point for the local authority to consider whether the provision of a preventative service or some other step is appropriate. These may include:

  • initial contact through a customer services centre, whether by the person concerned or someone acting on their behalf;
  • contact with a GP, community nurses, housing officers or other professionals which leads to a referral to the local authority;
  • an assessment of needs or a carer’s assessment (see Assessment chapter), which identifies the person may benefit from a preventative service or other type of local support.

Many people with low level care and support needs will approach the voluntary sector for advice in the first instance. Local authorities and the voluntary sector should work together on how it can share this information to gain a fuller picture of local need as possible. Authorities should bring data from these different sources together to stratify who in the community may need care and support in the future and what types of needs they are likely to have, and use this information to target their preventative services effectively.

Prevention should be a consistent focus for the local authority in undertaking their care and support functions. However, there may be key points in a person’s life or in the care and support process however, where a preventative intervention may be particularly appropriate or of benefit to the person. The local authority should consider circumstances which may help to identify people who may benefit from preventative support, for example:

  • bereavement;
  • hospital admission and or discharge;
  • people who have been recently admitted to or released from prison;
  • application for benefits such as Attendance Allowance, or Carer’s Allowance;
  • contact with/use of local support groups;
  • contact with/use of private care and support;
  • changes in housing.

A local authority must establish and maintain a service for providing people with information and advice relating to care and support (see Information and Advice chapter). In addition to any more targeted approaches to communicating with individuals who may benefit from preventative support, this service should include information and advice about preventative services, facilities or resources, so that anyone can find out about the types of support available locally that may meet their individual needs and circumstances, and how to access them.

5.7 Helping people access preventative support

A variety of different kinds of service, facilities or resources can be preventative and can help individuals live well and maintain their independence or caring roles for longer.

Local authorities should be innovative and develop an approach to prevention that meets the needs of their local population. A preventative approach requires a broad range of interventions, as one size will not fit all.

Where a local authority has put in place mechanisms for identifying people who may benefit from a type of preventative support, it should take steps to ensure that the person concerned understands the need for the particular measure, and is provided with further information and advice as necessary.

Contact with a person who is identified as being able to benefit from preventative support may lead to the local authority becoming aware that the person appears to have needs for care and support, including support as a carer. This appearance of need is likely to trigger a needs assessment or a carer’s assessment. However, where a local authority is not required to carry out such an assessment, it should nonetheless take steps to establish whether the person identified will benefit from the type of preventative support proposed.

Where a person is provided with any type of service or supported to access a facility or resource as a preventative measure, the local authority should also provide the person with information in relation to the measure undertaken. The local authority is not required to provide a care and support plan or a carer’s support plan where it provides prevention services only. It should, however, consider which aspects of a plan should be provided in these circumstances, and should provide such information as is necessary to enable the person to understand:

  • what needs the person has or may develop, and why the intervention or other action is proposed in their regard;
  • the expected outcomes for the action proposed, and any relevant timescale in which those outcomes are expected; and
  • what is proposed to take place at the end of the measure (for instance, whether an assessment of need or a carer’s assessment will be carried out at that point).

The person concerned must agree to the provision of any service or other step proposed by the local authority. Where the person refuses but continues to appear to have needs for care and support (or for support, in the case of a carer), the local authority must offer the individual an assessment.

6. Assessment of the Needs of Adults and Carers

See also Assessment chapter

In assessing whether an adult has any care and support needs or a carer has any needs for support, the local authority must consider whether the person concerned would benefit from the preventative services, facilities or resources provided by the local authority or which might otherwise be available in the community. This is regardless of whether, in fact, the adult or carer is assessed as having any care and support needs or support needs. As part of the assessment process, the local authority considers the capacity of the person to manage their needs or achieve the outcomes which matter to them, and allows for access to preventative support before a decision is made on whether the person has eligible needs (see Assessment chapter).

As part of this process, the local authority should also take into account the person’s own capabilities, and the potential for improving their skills, as well as the role of any support from family, friends or others that could help them to achieve what they wish for from day-to-day life. This should not assume that others are willing or able to take up caring roles. Where it appears to the local authority that a carer may have needs for support (whether currently or in the future), a carer’s assessment must always be offered.

Children should not undertake inappropriate or excessive caring roles that may have an impact on their development. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing and their prospects in education and life. A local authority may become aware that a child is carrying out a caring role through an assessment or informed through family members or a school. A local authority should consider how supporting the adult with needs for care and support can prevent the young carer from under taking excessive or inappropriate care and support responsibilities. Where a young carer is identified, the local authority must undertake a young carer’s assessment under the Children Act 1989.

Considering the support from family, friends or others is important in taking a holistic approach to see the person in the context of their support networks and understanding how their needs may be prevented, reduced or delayed by others within the community, rather than by more formal services.

If a person is provided with care and support or support as a carer by the local authority, the authority must provide them with information and advice about what can be done to prevent, delay, or reduce their needs as part of their care and support plan or support plan. This should also include consideration of the person’s strengths and the support from other members of the family, friends or the community (see Care and Support Planning chapter).

Regardless of whether or not a person is ultimately assessed as having either any needs at all or any needs which are to be met by the local authority, the authority must in any case provide information and advice in an accessible form, about what can be done to prevent, delay, or reduce development of their needs. This is to ensure that all people are provided with targeted, personalised information and advice that can support them to take steps to prevent or reduce their needs, connect more effectively with their local community, and delay the onset of greater needs to maximise their independence and quality of life. Where a person has some needs that are eligible, and also has some other needs that are not deemed to be eligible, the local authority must provide information and advice on services facilities or resources that would contribute to preventing, reducing or delaying the needs which are not eligible, and this should be aligned and be consistent with the care and support plan for the person with care needs, or support plan for the carer.

It is important that people receive information in a timely manner about the services or interventions that can help or contribute to preventing an escalation in needs for care and support. Supporting people’s access to the right information at the right time is a key element of a local authority’s responsibilities for prevention.

7. Charging for Preventative Support

Preventative services, like other forms of care and support, are not always provided free, and charging for some services is vital to ensure affordability. The Care and Support (Preventing Needs for Care and Support) Regulations 2014 continue to allow local authorities to make a charge for the provision of certain preventative services, facilities or resources. The regulations also provide that some other specified services must be provided free of charge.

Prevention services facilities or resources may not involve local authorities directly providing or commissioning a service. Some effective forms of prevention result from partnerships with other public services, voluntary and community organisations and other providers. In developing these partnerships local authorities should consider what obstacles there may be which might prevent people on low incomes from benefitting from the activities and take reasonable steps to avoid this.

Where a local authority chooses to charge for a particular service, it should consider how to balance the affordability and viability of the activity with the likely impact that charging may have on uptake. In some cases, charging may be necessary in order to make a preventative service viable or keep a service running.

When charging for any type of preventative support, local authorities should take reasonable steps to ensure that any charge is affordable for the person concerned. This does not need to follow the method of the financial assessment used for mainstream charging purposes; and the use of such a process is likely to be disproportionate.

However, local authorities should consider adopting a more proportionate or ‘light-touch’ approach which ensures that charges are only paid by those who can afford to do so. In any event, a local authority must not charge more than it costs to provide or arrange for the service, facility or resource.

The regulations require that intermediate care and reablement must be provided free of charge for up to six weeks, as must aids and minor adaptations (that is, adaptations up to the value of £1,000).

Where local authorities provide intermediate care or reablement to those who require it, this must be provided free of charge for a period of up to 6 weeks. This is for all adults, irrespective of whether they have eligible needs for ongoing care and support. Although such types of support will usually be provided as a preventative measure, they may also be provided as part of a package of care and support to meet eligible needs. In these cases, regulations also provide that intermediate care or reablement cannot be charged for in the first six weeks, to ensure consistency.

Whilst they are both time-limited interventions, neither intermediate care nor reablement should have a strict time limit, since the period of time for which the support is provided should depend on the needs and outcomes of the individual. In some cases, for instance a period of rehabilitation for a visually impaired person (a specific form of reablement), may be expected to last longer than six weeks. Whilst the local authority does have the power to charge for this where it is provided beyond six weeks, local authorities should consider continuing to provide it free of charge beyond six weeks in view of the clear preventative benefits to the individual and, in many cases, the reduced risk of hospital admissions.

Local authorities should consider the potential impact and consequences of ending the provision of preventative services. Poorly considered exit strategies can negate the positive outcomes of preventative services, facilities or resources, and ongoing low-level care and support can have significant impact on preventing, reducing and delaying need.

8. Further Reading

8.1 Relevant chapters

Promoting Wellbeing

Information and Advice

8.2 Relevant information

Chapter 2, Preventing, Reducing or Delaying Needs, Care and Support Statutory Guidance (Department of Health and Social Care)

See also Preventing, Reducing or Delaying Needs Case Studies, Resources

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CQC Quality Statements

Theme 1 – Working with People: Supporting people to live healthier lives

We Statement

We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.

What people expect

I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.

1. Introduction

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. Throughout the Care and Support Statutory Guidance (2016), the different chapters set out how a local authority should go about performing its care and support responsibilities. Underpinning all of these individual ‘care and support functions’ (that is, any process, activity or broader responsibility that the local authority performs) is the need to ensure that doing so focuses on the needs and goals of the person concerned.

Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.

The wellbeing principle applies in all cases where a local authority is carrying out a care and support function, or making a decision, in relation to a person. For this reason it is referred to throughout this guidance. It applies equally to adults with care and support needs and their carers.

In some specific circumstances, it also applies to children, their carers and to young carers when they are subject to transition assessments (see Transition to Adult Care and Support).

2. Definition of Wellbeing

Wellbeing is a broad concept, and it is described as relating to the following areas in particular:

  • personal dignity (including treatment of the individual with respect);
  • physical and mental health and emotional wellbeing;
  • protection from abuse and neglect;
  • control by the individual over day to day life (including over care and support provided and the way it is provided);
  • participation in work, education, training or recreation;
  • social and economic wellbeing;
  • domestic, family and personal relationships;
  • suitability of living accommodation;
  • the individual’s contribution to society.

The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering ‘wellbeing’ in the round.

3. Promoting Wellbeing

Promoting wellbeing involves actively seeking improvements in aspects of wellbeing set out above when carrying out a care and support function in relation to an individual at any stage of the process, from the provision of information and advice to reviewing a care and support plan. Wellbeing covers an intentionally broad range of the aspects of a person’s life and will encompass a wide variety of specific considerations depending on the individual.

A local authority can promote a person’s wellbeing in many ways. How this happens will depend on the circumstances, including the person’s needs, goals and wishes, and how these impact on their wellbeing. There is no set approach – a local authority should consider each case on its own merits, consider what the person wants to achieve, and how the action which the local authority is taking may affect the wellbeing of the individual.

The Act therefore signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. This is the core legal entitlement for adults to care and support, establishing one clear and consistent set of duties and power for all people who need care and support.

The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. The concept of meeting needs also recognises that modern care and support can be provided in any number of ways, with new models emerging all the time, rather than the previous legislation which focuses primarily on traditional models of residential and domiciliary care.

Whenever a local authority carries out any care and support functions relating to an individual, it must act to promote wellbeing – and it should consider all of the aspects above in looking at how to meet a person’s needs and support them to achieve their desired outcomes. However, in individual cases, it is likely that some aspects of wellbeing will be more relevant to the person than others. For example, for some people the ability to engage in work or education will be a more important outcome than for others, and in these cases ‘promoting their wellbeing’ effectively may mean taking particular consideration of this aspect. Local authorities should adopt a flexible approach that allows for a focus on which aspects of wellbeing matter most to the individual concerned.

The principle of promoting wellbeing should be embedded through the local authority care and support system, but how it promotes wellbeing in practice will depend on the particular function being performed. During the assessment process, for instance, the local authority should explicitly consider the most relevant aspects of wellbeing to the individual concerned, and assess how their needs impact on them. Taking this approach will allow for the assessment to identify how care and support, or other services or resources in the local community, could help the person to achieve their outcomes. During care and support planning, when agreeing how needs are to be met, promoting the person’s wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family). To give another example, the concept of wellbeing is very important when responding to someone who self-neglects, where it will be crucial to work alongside the person, understanding how their past experiences influence current behaviour. The duty to promote wellbeing applies equally to those who, for a variety of reasons, may be difficult to engage.

The wellbeing principle applies equally to those who do not have eligible needs but come into contact with the care and support system in some other way (for example, via an assessment that does not lead to ongoing care and support) as it does to those who go on to receive care and support and have an ongoing relationship with the local authority.

It should also inform delivery of universal services provided to all people in the local population, as well as being considered when meeting eligible needs. Although the wellbeing principle applies specifically when the local authority performs an activity or task or makes a decision in relation to a person, the principle should also be considered by the local authority when it undertakes broader, strategic functions, such as planning, which are not in relation to one individual. Wellbeing should, therefore, be seen as the common theme around which care and support is built at both local and national levels.

In addition there are a number of other key principles and standards to which the local authority must have regard to when carrying out the same activities or functions:

  1. The importance of beginning with the assumption that the individual is best placed to judge the individual’s wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing. Local authorities should not make assumptions as to what matters most to the person; there should be an assumption that the individual is best placed to understand the impact of their condition/s on their outcomes and wellbeing.
  2. The individual’s views, wishes, feelings and beliefs. Considering the person’s views and wishes is critical to a person centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.
  3. The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer (see Preventing, Reducing or Delaying Needs).
  4. The need to ensure that decisions are made having regard to all the individual’s circumstances (and are not based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the person’s circumstances, but should in every case work to understand their individual needs and goals.
  5. The importance of the individual participating as fully as possible. In decisions about them and being provided with the information and support necessary to enable the individual to participate. Care and support should be personal, and local authorities should not make decisions from which the person is excluded.
  6. The importance of achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. People should be considered in the context of their families and support networks, not just as isolated individuals with needs. Local authorities should take into account the impact of an individual’s need on those who support them, and take steps to help others access information or support.
  7. The need to protect people from abuse and neglect. In any activity which a local authority undertakes, it should consider how to ensure that the person is and remains protected from abuse or neglect. This is not confined only to safeguarding issues, but should be a general principle applied in every case including with those who self-neglect.
  8. The need to ensure that any restriction on the individual’s rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary. For achieving the purpose for which the function is being exercised. Where the local authority has to take actions which restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary. Concerns about self-neglect do not override this principle.

All of the matters listed above must be considered in relation to every individual, when a local authority carries out a function as described in this guidance. Considering these matters should lead to an approach that looks at a person’s life holistically, considering their needs in the context of their skills, ambitions, and priorities – as well as the other people in their life and how they can support the person in meeting the outcomes they want to achieve. The focus should be on supporting people to live as independently as possible for as long as possible.

As with promoting wellbeing, the factors above will vary in their relevance and application to individuals. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. Local authorities should consider how to apply these further principles on a case-by-case basis. This reflects the fact that every person is different and the matters of most importance to them will accordingly vary widely.

Neither these principles nor the requirement to promote wellbeing require the local authority to undertake any particular action; the steps it takes should depend entirely on the individual’s’ circumstances. The principles as a whole are not intended to specify the activities which should take placed. Instead, their purpose is to set common expectations for how the local authority should approach and engage with people.

4. Independent Living

Although not mentioned specifically in the way that wellbeing is defined, the concept of ‘independent living’ is a core part of the wellbeing principle. Section 1 of the Care Act includes matters such as individual’s control of their day-to-day life, suitability of living accommodation, contribution to society – and crucially, requires local authorities to consider each person’s views, wishes, feelings and beliefs.

The wellbeing principle is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention). Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The language used in the Act is intended to be clearer, and focus on the outcomes that truly matter to people, rather than using the relatively abstract term ‘independent living’.

5. Wellbeing throughout the Care Act

Wellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting people to live as independently as possible for as long as possible.

Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people’s needs for care and support and how meeting these can help them achieve the outcomes most important to them. Where someone is unable to fully participate in these conversations and has no one to help them, local authorities will arrange for an independent advocate. The chapters on Assessment, Eligibility, Care and Support Planning and Independent Advocacy discuss this in more detail.

In order to ensure these conversations look at people holistically, local authorities and their partners must focus on joining up around an individual, making the person the starting point for planning, rather than what services are provided by what particular agency. The chapter on Integration and Cooperation sets this out in more detail.

In particular, the Care Act is designed to work in partnership with the Children and Families Act 2014, which applies to 0 to 25 year old children and young people with SEN and Disabilities. In combination, the two Acts enable areas to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. This is considered in more detail in Transition to Adult Care and Support.

Promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them. People will have an opportunity to request their local authority support in the form of a direct payment that they can then use to buy their own care and support using this information. The chapter on Information and Advice explains this in more detail.

Control also means the ability to move from one area to another or from children’s services to the adult system without fear of suddenly losing care and support. The Care Act ensures that people will be able to move to a different area without suddenly losing their care and support and provides clarity about who will be responsible for care and support in different situations. It also includes measures to help young people move to the adult care and support system, ensuring that no one finds themselves suddenly without care on turning 18. The chapters on Continuity of Care, Ordinary Residence and Transition to Adult Care and Support set this out in more detail.

It is not possible to promote wellbeing without establishing a basic foundation where people are safe and their care and support is on a secure footing. The Care Act puts in place a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services. The chapters on Adult Safeguarding and Managing Provider Failure set this out in more detail.

6. The Role of the Principal Social Worker in Care and Support

The purpose of this section of the guidance is to further clarify arrangements to have in place a designated principal social worker in adult care and support. Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:

  • lead and oversee excellent social work practice;
  • support and develop arrangements for excellent practice;
  • lead the development of excellent social workers;
  • support effective social work supervision and decision making;
  • oversee quality assurance and improvement of social work practice;
  • advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice;
  • function at the strategic level of the Professional Capabilities Framework (British Association of Social Workers).

6.1 The local authority role in supporting principal social workers

All local authorities should ensure principal social workers are given the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level and are given sufficient time to carry out their role. The principal social worker should also be visible across the organisation, from elected members and senior management, through to frontline social workers, people who use services and carers. Local authorities should therefore ensure that the role is located where it can have the most impact and profile.

Whatever arrangements are agreed locally, the principal social worker should maintain close contact with the DASS and frontline practitioners and engage in some direct practice. This can take several different forms, including direct casework, co-working, undertaking practice development sessions, mentoring, etc.

The integration of health and care and support will increasingly require social workers to lead, both in their teams and across professional boundaries, particularly in the context of safeguarding, mental health and mental capacity. Organisational models of social work have traditionally focused on managerial, as opposed to professional leadership – through their direct link to practice, principal social workers can ‘bridge the gap’ between professional and managerial responsibility, to influence the delivery and development of social work practice.

6.2 Principal social workers and safeguarding

Chapter 14 of the Care and Support Statutory Guidance (2016) endorses the: ‘Making Safeguarding Personal’ approach (see Adult Safeguarding). This represents a fundamental shift in social work practice in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers should have a broad knowledge base on safeguarding and Making Safeguarding Personal and be confident in its application in their own and others’ work. Local authorities should, therefore, ensure that principal social workers lead on ensuring the quality and consistency of social work practice in fulfilling its safeguarding responsibilities. In particular they should have extensive knowledge of the legal and social work response options to specific cases and in general.

7. Further Reading

7.1 Relevant chapters

Preventing, Reducing or Delaying Needs

Information and Advice

7.2 Relevant information

Chapter 1, Promoting Wellbeing, Care and Support Statutory Guidance (Department of Health and Social Care)

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