KEY POINTS

  • Reviews may be planned or unplanned. Unplanned reviews may be progressed directly to a reassessment where it is in response to a significant change.
  • Planned reviews should consider progress against the personal outcomes set out in the plan.
  • Some reviews may be carried out as proportionate light touch or desktop reviews with contributions from the person, carers and care provider.

December 2018: This chapter has been revised as a result of local review. In particular, Section 1, General Principles of Review and Reassessment has been revised and Section 3, Reviews for Self-Funders is new.

1. General Principles of Review and Reassessment

Chapter 13, Review of Care and Support Plans, Care and Support Statutory Guidance states:

Ensuring all people with a care and support plan, or support plan have the opportunity to reflect on what is working, what is not working and what might need to change is an important part of the planning process. It ensures that plans are kept up to date and relevant to the person’s needs and aspirations, provides confidence in the system, and mitigate the risk of people entering a crisis situation.

The review process should be person-centred and outcomes focused, as well as accessible and proportionate to the needs to be met. The process must involve the person needing care and also the carer where feasible, and consideration must be given whether to involve an independent advocate who local authorities are required to supply in the circumstances specified in the Act.

Reviewing intended outcomes detailed in the plan is the means by which the local authority complies with its ongoing responsibility towards people with care and support needs. The duty on the local authority therefore is to ensure that a review occurs, and if needed, a revision follows this. Consideration should also be given to authorising others to conduct a review – this could include the person themselves or carer, a third party (such as a provider) or another professional, with the local authority adopting an assurance and sign-off approach.

The review will help to identify if the person’s needs have changed and can in such circumstances lead to a reassessment. It should also identify other circumstances which may have changed, and follow safeguarding principles in ensuring that the person is not at risk of abuse or neglect. The review must not be used as a mechanism to arbitrarily reduce the level of a person’s personal budget.

The review should be a positive opportunity to take stock and consider if the plan is enabling the person to meet their needs and achieve their aspirations. The process should not be overly-complex or bureaucratic, and should cover these broad elements, which should be communicated to the person before the review process begins:

  • have the person’s circumstances and/or care and support or support needs changed
  • what is working in the plan, what is not working, and what might need to change
  • have the outcomes identified in the plan been achieved or not
  • does the person have new outcomes they want to meet
  • could improvements be made to achieve better outcomes
  • is the person’s personal budget enabling them to meet their needs and the outcomes identified in their plan and
  • is the current method of managing it still the best one for what they want to achieve, for example, should direct payments be considered
  • is the personal budget still meeting the sufficiency test
  • are there any changes in the person’s informal and community support networks which might impact negatively or positively on the plan
  • has there been any changes to the person’s needs or circumstances which might mean they are at risk of abuse or neglect
  • is the person, carer, independent advocate satisfied with the plan

Lincolnshire Adult Care monitors performance information on the number of people who have had a review and the number of reviews completed within the scheduled target end date. Information about our key performance indicators can be viewed in Values and Principles of Adult Care, Key Performance Indicators.

All open cases should have a responsible key team allocated to them and should all be subject to a review, as described below.

Reviews and reassessments should be viewed and recorded as separate entities. The Care Act describes reviews as either planned or unplanned reviews. Planned reviews should only require the recording of the review event on the review form, unless we identify significant changes in need, in which case the review should trigger a further assessment to be undertaken.

In situations where significant changes with existing customers have triggered a need for a reassessment, for example, after a hospital admission, referrals will lead to the planned/scheduled review being brought forward to initiate the reassessment.

2. Planned Reviews

  • Arrangements for reviews, including the frequency, who should be involved, and the type of review, should be agreed as part of the care and support planning process.
  • A first review should take place within 6-8 weeks of support starting, both for new or former customers with new care and support, and for existing customers where new services have been arranged. This review should be undertaken by the original assessor/team responsible for the assessment and planning work and may be a light touch review if appropriate (see desktop reviews, below).
  • Thereafter, people should have a review at least once per year, as a minimum requirement.
  • There may be circumstances where more frequent reviews are required. This should be based on a professional decision determined by the person’s needs and circumstances, for example, in response to changes in the person’s needs or where the elements of the support arrangements are problematic.

2.1 Desktop reviews

  • The Care Act supports the principle that reviews should be proportionate and that they can be carried out on the council’s behalf by other professionals, organisations or the person themselves, with the council adopting an assurance and sign off approach (see Chapter 13, Review of Care and Support Plans, Care and Support Statutory Guidance).
  • The term ‘desktop review’ describes a review where it is not necessary to have a face to face meeting with the person receiving support and those involved. Information may be sought by telephone or through written submission of information or a combination of these.
  • This lighter touch approach to reviewing may also be appropriate for key workers undertaking reviews when actively working with customers for example, initial reviews following the implementation of new care and support plans or changes to services.
  • Scheduled annual reviews which have been allocated to assessment practitioners should ordinarily be face to face, on the basis that they do not meet the criteria set out for desktop reviews.

The following prerequisites should be applied in determining a customer’s suitability to have a desktop review, irrespective of who carries it out:

  • the customer must have capacity to agree to the next planned review being undertaken over the telephone and not have any cognitive impairments which may prevent them contributing to the review;
  • they must be able to communicate and engage by telephone.

2.2 Scheduling desktop reviews

Providing the person is suitable for a desktop review and receiving support in their own home, planned reviews should be done as a desktop review.

  • All Carers Reviews and reviews where the only service received is Telecare will be undertaken as telephone reviews.
  • A customer should go no more than two years without being seen face to face by an assessor.

For example:

The face to face assessment was undertaken by a practitioner in August 2017. A light touch, desktop review was undertaken by the practitioner in October 2017.

All is well and appropriate to schedule the annual review, to be undertaken as a desktop review, in October 2018.

In October 2018, all is found to be well, however the last time the person was seen was August 2017, so next annual review should be planned for October 2019 as a face to face review by the area team.

Any unplanned reviews or reassessments in the intervening time will lead to the cycle being ‘re-set’.

Telephone reviews should not be considered or undertaken if any of the following apply:

  • customers who are in residential or nursing care at the time of the review (this applies to respite care, short-term and long-term residential and nursing care);
  • customers who have had a temporary change (increase or decrease) of services since their last recorded review (or reassessment);
  • customers who are in receipt of a direct payment;
  • customers open to Learning Disability Teams, or who are receiving services funded by Learning Disability Teams;
  • customers who have had two or more ‘contacts raised’ indicating an unstable support plan or ‘fluctuating change in needs / circumstances’ raised in the last 12 months;
  • customers whose cases are flagged as complex cases;
  • customers who have had safeguarding involvement in the last 12 months;
  • where there is a current outstanding complaint or there has been a resolved complaint in the 12 months prior to the review date.

3. Reviews for Self-Funders

People who have made their own arrangements for care and support and are meeting the full cost of their care are not usually kept open to a key team.  Self-funders may contact Adult Care for information and advice and are entitled to an assessment or reassessment should they request one, but will not be subject to scheduled annual reviews.

Self-funders who have requested that the local authority arrange their care and support through our commissioned services and have paid an arrangement fee will remain open to a key team and receive proportionate scheduled reviews.

4. Unplanned Reviews

Any review undertaken outside of a planned review cycle is referred to as an unplanned review. It is usually undertaken in response to a contact (referred to as a ‘subsequent contact’) regarding an existing case.

Cases open to a key worker at the point a review becomes needed or is requested, will be dealt with by the key worker as part of their case work. People who are receiving care and support but do not have a key worker will be open to a key team. Requests for unplanned reviews on inactive cases will trigger a new contact to be recorded to initiate further involvement.

Procedures for recording unplanned review requests vary depending on whether the person is in the community or hospital, and depending on the nature of the concern being raised.

Most requests for unplanned reviews come either through the Customer Service Centre (CSC) for people in the community or out of county hospitals, or from referrals directly into hospital social work departments for patients at the three main Lincolnshire hospitals.

4.1 Requests received by the Customer Service Centre

The customer advisors will first check whether the case is allocated to a key worker and, if so, transfer the case to them. For inactive cases without a key worker, the customer advisor will:

  • record a contact and gather the basic information around why the request is being made. If the matter can be dealt with by the advisor without the need to bring forward a review, for instance, by provision of information and advice, there will be no further progression;
  • where the contact indicates that changes are required, the review should be brought forward. The advisor will bring forward the review and either record it proportionately themselves or assign the review to another practitioner within the CSC or area team;
    • this review may lead to small changes to support arrangements where there are sufficient funds in the personal budget. This can be done at the CSC by either a practitioner or appropriately skilled advisor following the defined process;
  • where immediate intervention is required, assign the review and any subsequent reassessment to a practitioner based within the CSC, who will complete the initial review and, if necessary, a reassessment, before transferring the case to the relevant area team;
  • where there is a clear need for a reassessment or for changes outside of the current personal budget, the review should be completed briefly and proportionately to trigger the reassessment, but that reassessment should be assigned to the relevant area team;
  • where there is not an immediate crisis needing intervention by the CSC teams, or a more intensive piece of case work is needed, transfer the request through to the relevant area team.

4.2 Requests received by hospital social work departments

  • Contacts will be recorded and cases will be allocated to hospital based practitioners, who will monitor progress through multi-disciplinary meetings and contact with ward staff.
  • At the point it becomes appropriate for Adult Care to review the person’s needs, the practitioner will bring forward the persons planned review and where necessary, trigger a new assessment.
  • Where people have a key worker, the hospital and area practitioners may need to liaise in order to decide about the appropriateness of the key worker coming into the hospital to undertake the review and reassessment with the person.

5. Changing the Annual Review Cycle

An unplanned review which involves a previously planned review being brought forward will change the annual review cycle. Future reviews should be scheduled following the reassessment and any changes to care and support plans to ensure that all customers have a review planned within the year, as a minimum.

To maximise efficiency and improve joint working, it is Lincolnshire County Council’s aim to coordinate review cycles with other professionals, wherever possible. Where reviews and reassessments have involved reviewing Continuing Healthcare (CHC) eligibility, practitioners should endeavour to ensure that future review dates coincide with future CHC reviews.

6. Copying Forward Assessments

The functionality to copy forward previous assessments is designed to provide a foundation for a reassessment by providing previously recorded information to refer back to and build on.

The practitioner is responsible for ensuring that the assessment they undertake reflects the current needs and circumstances of the person.

Any wording from a previous assessment, which is outdated and which no longer reflects the person’s needs, should be overwritten or deleted. This will ensure that the person’s assessment is always as current and accurate as possible.

7. Arranging out of County Reviews

Reviews for people who are the funding responsibility of Lincolnshire County Council, but who are placed or supported to live in another council’s area, are known as out of county reviews.

Out of county reviews which are to be carried out in person will require travel to the host area or for arrangements to be made with the local authority in the host area to undertake the review on Lincolnshire’s behalf. The Arranging Out of County Reviews guidance (Lincolnshire County Council intranet) is intended to achieve consistency in our approach to out of county reviews.

All out of county learning disability service reviews will be undertaken by Lincolnshire practitioners.

Lincolnshire County Council operates charges for assessments undertaken on behalf of other authorities. The charge is set out in the Scheme of Charges. An invoice should be raised and the fee is received in to the staffing budget of the team doing the work.

For further information on charging for assessments undertaken on behalf of other Local Authorities please contact the Adult Care Finance Team at AdultCareFinance@lincolnshire.gov.uk