Timing

The art of good … –

      – Timing.

– …comedy is ….

(An old joke – or, rather, an upcycled joke: one which may or may not work in this medium!)

So what’s this about? The timing of different aspects of the Care Act functions that have to be delivered by councils….

I’m already being asked, mostly by family carers at the moment, if there are any targets or time limits within which local authorities have to be complete certain things – the stages of that customer journey, for instance.

They mean the stages that are currently essential in their lives, or in the lives of the person they care for, such as:

• assessments for care/ support
• eligibility decisions
• actual provision of care, or support – including preventative support.

Carers want to know what arguments they can use to get authorities moving faster. To those people, in the most part, I rather sadly shake my head and bemoan the loss over the last several years of helpful targets: the ones that people used to use to support their situation, such as the maximum time between first making contact and the assessment being completed; or how quickly post-assessment decisions had to be made and shared. All long gone.

What we currently have in the Care Act are very few actual time limits. For those who have got all the way through the eligibility process to find unmet eligible needs for which their council is taking responsibility, there are time limits relating to reviewing the care plan (initially at 6 weeks, and then at least every 12 months – at least an expectation that the gaps will be no longer than that), and time limits for reviewing agreed direct payments. There are still – in section 74 and Schedule 2 to the Act – time limits relating to hospital discharge of NHS patients for whom (the NHS believes) leaving hospital is not likely to be safe without some care and support post-discharge.

There is even a rather extraordinary time limit on the face of the Act itself, in section 29, for local authorities to retain care accounts (relating to the care cap, yet to come into force at the time of writing this particular post) until either it becomes aware of the person’s death, or for 99 years starting with the day on which it last updated the account.

But these are all time limits on the State, once it has taken responsibility to do something. For those trying to get the State to do something that might ultimately mean the adult or carer might be on the receiving end of that responsibility – to finish an assessment, for example – may have to rely on the Guidance saying that the process being carried out should be done in a timely manner.

However, the guidance particularly around assessment could and should still be helpful to adults and carers. At present, in some areas at least there are reports of two factors historically contributing to delaying the completion of assessments, or of making decisions about eligibility:

• ‘Pausing’ the assessment for preventative support, where in fact the person is being placed on an apparently indefinite  waiting list for a preventive service (including community aids and adaptations);
• Insisting that a medical diagnosis is necessary in all cases to proceed with eligibility decisions.

The guidance says: (with bold font added for emphasis)

‘6.29 An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.’

Clearly, this could aid adults and carers particularly if their council hasn’t told them a likely timescale, and isn’t keeping them informed: leaving people indefinitely mid-system is no more a valid option than not keeping them up to date.

Other parts of the guidance may also help in situations where adults and carers are facing delays, such as being told there has to be a medical diagnosis (bold added for emphasis):

‘6.105. The first condition that local authorities must be satisfied about is that the adult’s needs for care and support are due to a physical or mental impairment or illness and that they are not caused by other circumstantial factors. Local authorities must consider at this stage if the adult has a condition as a result of either physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury. The authority should base their judgment on the assessment of the adult and a formal diagnosis of the condition should not be required.’

Unless the authority can give a good reason why a formal diagnosis is needed for a specific individual, for the thinking required by the Act, the decision-making process should not be delayed – and, if they did delay without a good reason, there would be strong grounds for a complaint or more. Applying a blanket policy (that everyone must have a formal diagnosis) would likely be open to a much stronger challenge.

Deciding to pause an assessment to allow for preventive support to be put in place is encouraged, providing of course this is deemed to be

a) helpful and suited to that particular person and – critically –

b) the support is actually put into place. Interrupting an assessment simply to put someone onto a known waiting list for one of these services, and calling it a ‘pause’ in the assessment is unlikely to cut the legal mustard (emphasis added):

‘6.25 Local authorities should not, however, remove people from the process too early. Early or targeted interventions such as universal services, a period of reablement and providing equipment or minor household adaptions can delay an adult’s needs from progressing. The first contact with the authority, which triggers the requirement to assess, may lead to a pause in the assessment process to allow such interventions to take place and for any benefit to the adult to be determined.…….’

The government suggested that the Care Act would save money by clarifying legal issues, and thus saving time and costs on litigation. But one of the issues that arises as State systems become more complex, and particularly when resources become more stretched (everyone’s resources, that is – not only local councils, but the resources of individuals and their community and personal networks) is that adults and carers may need to – and increasingly will – themselves become Legally Literate.

Lorna Easterbrook

About Lorna Easterbrook

Lorna blogs about Older People and Carers. Lorna's work covers health, social care, and housing - mostly with and for older people and, more recently, working carers. She trains, talks, informs, evaluates, reviews, develops, analyses, writes, and makes short films. Her professional background includes working for a Care & Repair scheme in the south Wales valleys, for Age UK, and the King's Fund. She has also been a family carer. As well as running her own consultancy, Lorna is an Associate of Community Catalysts, and a Trustee of Care & Repair England.

One thought on “Timing”

  1. Amir

    I find it a positive that carers’ assessments will have regard to the carer’s participation in education. However will this assessment take into account the financial cost for the carer as this can place a financial burden on the family through loss of benefit entitlement. Will this bill address the concerns that carers feel that there is lack of support for carers entering the education sector due to the extra financial resources then needed to care for the child in need i.e extra childminder cost whilst carer is in education. Obviously the finances change when the child in need reaches 18, so will the carer still receive the same financial support if they are in education when the child in need is in this transitional period? More guidance and clarity is needed in regard to this matter. From a political perspective it makes logical sense for carers to be able to be fully supported if they want to enter education; as for many carers this is central to their mental wellbeing, and thus would be beneficial in the long term in regards to the extra support needed if the carer’s well-being declined.

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