3. Working with The Amended Duties: Social Care Decision Making and Delivery Under The 2020 Act
3.1 Overarching duties
Local authorities should remain committed to delivering quality assessment, choice in how services and support are delivered, and control to people who use them. There will be significant additional pressure within the entire social care system across children, families, adults and older people.
Decisions should be made upholding the principle that every person and their human rights, personal choices, safety and dignity matters.
The vital role that unpaid carers play in supporting friends and relatives will become even more important over the coming months. Recognising and supporting them in their caring roles will play an indispensable role in supporting the social care system as a whole.
Leadership at all levels will be critical in working with the social care assessment provisions in the 2020 Act.
Chief Officers should evidence collective leadership, making collaborative decisions when there may be an impact on partner services, and operating to agreed processes, thresholds and assessments of risk.
Leaders should be visible and accessible to the frontline workforce. They should support their workforce to focus on what matters to people and what delivers the best outcomes in the circumstances.
Leaders should encourage their frontline workers to take steps to reduce unnecessary bureaucracy.
3.3 Prioritising risk to people
There will be extra support needs at this time. The Scottish Government has committed to meeting the additional costs of this. However, there will still be significant system pressures brought about by carer and care staff sickness and self-isolation.
Areas of key priority for either a full or a partial assessment during the crisis are:
- Risk to life
- Risk to a person's immediate health through not being able to wash, eat and look after themselves independently
- Child and adult protection
- Ability of carers to continue to provide care
- Existing complex care arrangements, including where a person lacks capacity
3.4 Support which may be available without formal assessment
There will be many requests for support that will be best directed straight to community groups and third sector organisations. Enhancing the capacity of these partners and ensuring good communication to the public about what is available and who to contact will help to reduce referrals for formal assessment
3.5 Full and partial assessments
The 2020 Act allows assessment activity to be prioritised. Assessment can be viewed as a process across a continuum of levels and domains carried out through short assessment to full standard assessment.
All assessments other than full should be regarded as temporary. No life changing decisions such as moving permanently into a care home should be taken without a full and complete assessment. This is consistent with section 17(7) to (9) of the 2020 Act, which allows for circumstances where a person is expected to become a permanent resident but a full assessment has not yet been carried out. In those cases the final decision will still be made following a full assessment but the 2020 Act allows retrospective charging for the earlier period.
3.5.1 Full assessments
Unless a full assessment has been undertaken any resulting care plan will be considered temporary. There is an expectation that temporary care plans will be reviewed regularly. Local authorities will have to prioritise the full assessment as soon as possible, based on risk. To qualify as a full assessment, the assessment must meet all the requirements of the relevant legislation (either section 12A of the 1968 Act, sections 23 or 29 of the 1995 Act or sections 6 or 12 of the 2016 Act). They must also comply with the general principles in section 1 of the 2013 Act to fully involve the supported person in decision making about their social care support.
3.5.2 Partial assessments
The 2020 Act relaxes duties to assess in order to speed up the time taken to put care and supports in place for people. Although a full assessment may not be required, a partial assessment should still be undertaken so that the worker can understand the person's level of need and what the most appropriate response to that would be.
Assessment is usually an ongoing process over time based on relationships between workers and people who may need care and support. A pared down approach can be used focusing on key areas – see bullets below. The level to which the assessment is reduced will depend on the circumstances. It must be proportionate to the complexity of the situation.
Workers should ensure first and foremost that the person is not at risk of harm to themselves or others. To meet urgent needs, workers will need to be creative, know their community assets and use their skills to respond to people's needs. They must work with the person's identified strengths, with their family and available community assets, acknowledging that and seek to make the right connections with communities and care and support organisations.
The workers should focus on having conversations with the person on the key areas which include being safe and healthy, active; maintaining positive relationships and living independently, as follows:
- Are they Safe (In their own home) and/or at their any Child or Adult Protection Concerns or issues around their cognitive capacity?
- Are there any issues with their physical or mental Health?
- Are they able to stay Active? Daily physical activity such as seated exercise, walking indoors or outdoors, exercise videos, and purposeful activities and hobbies.
- Are the able to maintain positive Relationships at this time? And do they have family supports or carers?
- Able to live Independently (food, comfort, financial maximisation)
- Are they a Carer who needs access to care and supports to undertake their caring role?
- Can the person identify their own Contingencies when supports not able to deliver?
- What else is important to the person?
Communication with family and friends, particularly anyone likely to take on a caring role, will continue to be important. Wherever someone is likely to be providing support as an unpaid carer, authorities should find out about the carer's ability and willingness to care, find out about any needs for support to continue caring and encourage them to look after their own health and wellbeing.
The assessment process should also consider people's own use of technologies including telecare and how they wish to communicate with the worker/team. The use of familiar platforms like Messenger, WhatsApp, Snapchat, etc. should be considered.
Where there are capacity issues, liaising with a Guardian or person with power of attorney (POA) may be necessary and or the use of communication aids to be able to have a 'good conversation' with the person around their needs and the care and supports that can be delivered.
3.6 Partial adult carer support plans and young carer statements
As well as being the mechanism to identify carers' needs for support, adult carer support plans and young carer statements also provide carers with important information to enable them to manage their caring role. Therefore in addition to the considerations outlined in the preceding section, authorities should cover the following in communicating with carers who have not had a full adult carer support plan or young carer statement.
Authorities should ensure family and anyone likely to take on a caring role know about:
- any funded social care support for the person with care needs – including any potential changes to that support during the outbreak period;
- what support the person might need from family and friends, including information on how to provide that support safely to prevent infection;
- how to access any supplies needed for their caring role, including personal protective equipment where this is needed to minimise risk of infection;
- who to contact if the caring situation is not working, or if the unpaid carer is unable to continue for a period, if they become unwell or need to self-isolate.
For individuals at higher risk of infection, subject to shielding, authorities should also ensure families and unpaid carers are aware of:
- any additional support for this group;
- any additional measures they should be taking to avoid risk of infection.
Unpaid carers should be encouraged to look after their own health and wellbeing:
- encouraging them to share their responsibilities with others;
- encouraging them to work out a plan with others for what happens if they are unable to continue caring if they become ill or need to self-isolate;
- making sure they are aware of local sources of emotional and other support for unpaid carers, such as local carer centre support, and how it can be accessed during the outbreak period.
3.7 Delegating assessments and budget decision making
3.7.1 Delegating assessments
Social workers remain the responsible professionals for assessments. Social care assessments can be delegated (as they often already are to social work assistants and/or other professionals). During the pandemic, it may sometimes be necessary to delegate more complex assessment tasks to others where this can be done safely. Where people have complex protection or capacity needs, where risk to the person or others is high or where life-changing and potentially permanent decisions need to be made, these will be priorities for registered social workers.
Other registered professionals including occupational therapists, physiotherapists, and nurses should feel confident to undertake a partial assessment. Where assessments need to be undertaken quickly by someone who might not ordinarily undertake that type of assessment or where the assessment has been partial, the resulting care plan will be temporary and subject to regular review and a full assessment as soon as is practical.
3.7.2 Delegating budget decision making
During this crisis, there will be increased pressure on services with fewer staff including budget holders and decision makers. To function quickly and effectively, local authorities should consider temporary adjustments to their schemes of delegation to ensure workers are able to put care and support in place without delay.
Where safe to do so, workers will require increased delegated responsibility to undertake their roles to get services to people quickly and to access budgets to pay for care and support. Local partnerships should determine what purchasing decisions can be delegated to whom and to what level.
3.7.3 Supporting staff
Workers who are being asked to take on more autonomous decision making should be fully supported to do so. What workers can and cannot make decisions about should be made clear by leaders and line managers. Workers should expect support from their managers and leaders to take professional decisions to a level proportionate to the worker's experience and competence.
Where workers need support to make decisions, they should have easy access to support. This may take the form of a mentor, a line manager, or a team manager. Support arrangements should be clearly stated to the worker.
Safe and effective practice change cannot happen without effective communication to all levels of staff across the organisation. Workers should be informed clearly about any changes to practice. All accessible technologies should be considered to disseminate information.
3.8 Considering how and when to assess
3.8.1 In person or remote assessment
The decision whether an assessment can be done in person or remotely will need to be individually risk assessed taking into account:
- The quality of information held on current systems which is available to help make temporary care decisions
- Information from family members, friends, unpaid carers and current care workers
- The urgency of the need for support
- The vulnerability of the person
- The risk of transmission of the virus to the person and to workers.
3.8.2 Using telecare
Many vulnerable people will already be connected to telecare (community alarm). Early thought should be given about using the capacity of such systems to check that people are coping as well as to do rapid reviews of temporary care plans. The next of kin of people receiving telecare services will be on file so can be contacted when there are concerns about the level of vulnerability.
3.8.3 Children's services
In children's services, key point of contact will have information about children who may be on the cusp of needing a higher level of intervention. For areas that have not already done so, contact and contingency arrangements should be considered for those at risk of harm or neglect
A short self-assessment tool that can be completed by the referrer might enable the initial triage in coming to better decisions more quickly about where priorities lie. This might also reduce the volume of calls and lengths of time spent on initial discussions at points of first contact and can provide a starting point for further discussion. This approach is in line with the principles and spirit of the 2013 Act and supports people to begin to think about their own strengths and the capacity of their families and communities.
3.9 Providing support
3.9.1 Eligibility criteria
The 2020 Act only relaxes assessment duties. It does not relax any of the duties to provide services and support. Nor does it alter eligibility criteria in relation to adult social care or carer support.
3.9.2 Self-directed support options
The 2020 relaxes assessment duties and the duty to comply with the self-directed support principles in section 1 of the 2013 Act. It does not relax duties to offer the self-directed support options.
Some support may not be available in the person's preferred SDS option, so flexibility should be used in providing service in order to meet priority needs.
3.10 Review cycle
All assessments other than full should be regarded as temporary. These should be reviewed as well as possible at regular intervals. It is important that care and supports are reviewed to check whether outcomes have been achieved or are on track.
In many instances, reviews may be done by telephone, and, when capacity is severely limited, should ensure that people are managing with their care arrangements.
3.11 Recording decisions
Local authorities should keep a record of decision making during any period when section 16 is switched on. That should include decisions to dispense with the duty to assess, decisions to conduct full or partial assessments and decisions about the provision of support.
For adults with incapacity, this should include the situation of those adults moved or discharged from hospital without a full or any needs assessment under the emergency bill's provisions, including those who are subsequently identified as lacking capacity. The local authority should keep basic data including the name, date of birth, current placement, new location, and the date of move of the adult. Once this data has been collected, the local authority should pass information in respect of people who lack capacity onto the Mental Welfare Commission.
The Mental Welfare Commission will keep a register of adults who lack capacity who have to be discharged from hospital without a full or any needs assessment as a result of Covid-19.
3.12 When section 16 is switched off?
Once the emergency provisions are switched off, all the affected assessment duties will switch back on. A review of the decisions taken under the emergency legislation should take place.
Arrangements should be made to conduct assessments for people who did not receive a full assessment while section 16 was switched on.
For adults with incapacity, a review of those adults subsequently identified as lacking capacity should follow the principles of the AWI Act and the recommendations of the United Nations Convention on the Rights of Persons with Disability.